General Surgery EOR Exam Study Guide

Cardiac Disease (surgical recall p 96) (pocket notebook 15-1) • MI o Periop MI risk: § Goldman criteria for noncardiac surgery – RF include: • CHF (check EF à if 35% = no surgery) • MI w/in 6 months (check EKG à stress test à cath à reperfusion) • Arrhythmia • Age 70 • Emergent surgery • Aortic stenosis, poor medical condition, thoracic or abdominal procedure o Most dangerous period for a post-op MI are the 6 months following a previous MI (2/3 occur on post-op days 2- 5) o Risk factors for post-op MI: Hx of MI, angina, QS on EKG, S3, JVD, CHF, aortic stenosis, advanced age, extensive surgical procedure o Often presents with chest pain o May present with new onset CHF, new onset dysrhythmia, hypotension, chest pain, tachypnea, tachycardia, N/V, bradycardia, neck pain, arm pain o EKG findings: inverse T waves, ST elevation, ST depression, dysrhythmias (new onset a fib, PVC, vtach) o Labs: troponin I, cardiac isoenzymes • Unstable Angina o Previously stable and predictable symptoms of angina that are now more frequent, increasing or present at rest • Valvular Disease o Systolic Murmurs § Aortic stenosis: harsh systolic ejection crescendo-decrescendo murmur at the right upper sternal border (aortic area) with radiation to the neck and apex heard best by leaning forward with expiration • Dyspnea à chest pain à syncope with exercise § Pulmonic stenosis: harsh, loud, medium pitched systolic murmur heard best at the 2nd /3rd left intercostal space (pulmonic area) that may decrease with inspiration § Mitral regurgitation: holosystolic high-pitched blowing murmur at apex (mitral area) that radiates to axilla with a split S2 § Tricuspid regurgitation: high pitched holosystolic murmur at LLSB (tricuspid area) radiates to the sternum and increases with inspiration § Mitral valve prolapse: midsystolic ejection click heard best at the apex (mitral area) o Diastolic Murmurs § Aortic regurgitation: soft early diastolic blowing murmur along left sternal border with patient sitting leaning forward after exhaling § Pulmonic regurgitation: high pitched early diastolic decrescendo murmur at the LUSB (pulmonic area) that increases with inspiration § Mitral stenosis: diastolic low pitched decrescendo rumbling murmur with opening snap heard best at the apex (mitral area) with patient in lateral decubitus position § Tricuspid stenosis: diastolic rumbling murmur at the LLSB (tricuspid area) with an opening snap