Preoperative Cardiac Risk Assessment: Approach & Guidelines
|
|
|
- Charleen Bridges
- 5 years ago
- Views:
Transcription
1 Preoperative Cardiac Risk Assessment: Approach & Guidelines By, Liam Morris, MD., FACC (02/03/18)
2 CPG : Clinical Practice Guidelines GDMT : Guidelines Directed Medical Therapy GWC : Guideline Writing Committee ERC : Evidence Review Committee RCT : Randomized Clinical Trials MACE : Major Adverse Cardiac Events (Death and Nonfatal MI) ACS : Acute Coronary Syndrome
3 Definitions Emergency procedure : One in which Life or a Limb is threatened, < 6 hours Urgent Procedure : One in which Life or a Limb is threatened, typically between 6 and 24 hours Time sensitive procedure : 1 6 weeks (Oncologic procedures) Elective procedure : The procedure could be delayed up to 1 year
4 Low Risk procedure : Combined surgical and patient characteristics predict a MACE or MI of less than 1% (Plastic Surgery, Cataract Surgery) Elevated Risk procedure : Risk of MACE of greater than or equal to 1%
5 Functional Capacity METs : Metabolic Equivalents, where 1 MET is the resting or basal Oxygen consumption of a 40 year old, 70 kg man Classification: Excellent : > 10 METs Good : 7 10 METs Moderate : 4 6 METs Poor : < 4 METs (Slow Ballroom Dancing, Golfing & Walking at 2 3 mph)
6 Key Point Walking up a flight of Stairs Heavy house work Walking at 4 mph > 4 METs
7 Stepwise Approach Step 1 Determine the Urgency of Surgery - if EMERGENT; Determine the clinical risk factors that may influence perioperative management, and proceed to Surgery with appropriate monitoring and management strategies based on clinical assessment
8 Step 2 If Urgent or Elective; Determine if the patient has an ACS
9 STEMI UA/NSTEMI Decompensated Heart Failure (Peri partum Cardiomyopathy) Significant Arrhythmias Severe Valvular Heart Disease (2 D ECHO preoperatively in Moderate to severe Valvular Heart Disease if not performed in the last year, or if there is a change in clinical status)
10 When your back is against the wall Reasonable to proceed to Surgery if; a) Asymptomatic + Severe AS (Class II A) b) Asymptomatic + Severe MS (Class II B) c) Asymptomatic + Severe AI (Class II A) d) Asymptomatic + Severe MR (Class II A) (Swan - Ganz Catheter Placement, TEE)
11 Pulmonary Vascular Disease Increased perioperative risk; a) WHO Group 1 Pulmonary HTN b) Pulmonary Artery Systolic Pressures of > 70 mmhg c) Moderate (or greater) RV Dilatation/Dysfunction d) Pulmonar Vascular Resistance > 3 Wood Units e) NYHA Class III or IV Heart Failure (due to Pulmonary HTN) (Pulmonary HTN Specialist, Right Heart Catheterization)
12 Step 3 Estimate the Risk; NSQIP Risk Calculator RCRI Score a) Low Risk for MACE (0 0r 1 risk factor) b) Elevated Risk for MACE (greater than or equal to 2 risk factors) 1) High Risk Type of Surgery (Vascular surgery, Intraperitoneal and Intrathoracic surgeries) 2) H/O Ischemic Heart Disease (H/O MI, Pathological Q Waves on EKG, + Stress Test, Nitrate Therapy or Angina) 3) History of Heart Failure 4) H/O Cerebrovascular Disease 5) Diabetes Mellitus requiring treatment with Insulin 6) Preoperative Serum Creatinine of > 2 mg/dl
13 Step 4 If the patient has Low Risk (o or 1 Risk factor) of MACE (< 1%), proceed with Surgery
14 Step 5 If the patient has elevated risk of MACE (greater than or equal to 1%), then determine the Functional Capacity. If greater than or equal to 4 METs, proceed with Surgery.
15 Step 6 If Functional Capacity is poor (< 4 METs), then consult with the patient to determine if further testing would impact patient decision making. If Yes, then perform a Pharmacological Cardiac Stress Test (especially if Functional Capacity cannot be determined) If normal, proceed to Surgery with GDMT If abnormal, consider Coronary Angiography & Revascularization based on the extent of the abnormal Stress Test
16 Step 7 If testing does not impact decision making or care, to proceed to Surgery with GDMT or explore non invasive therapies
17 Preoperative EKG Class IIA : Reasonable for H/O Heart Disease, PAD, CVA (LOE: B) Class III : Routine testing is not useful for asymptomatic patients undergoing Low Risk Surgery (LOE: B)
18 Preoperative ECHO Class II A : a) Dyspnea of unknown origin (LOE: C) b) Heart Failure patients with worsening Dyspnea or change in clinical status (LOE: C) Class III : Routine Echocardiography is not recommended
19 Preoperative Stress Testing DSE (Dobutamine Stress ECHO) or MPI (Myocardial Perfusion Imaging) a) Moderate to large areas of Myocardial Ischemia is associated with increased risk of perioperative MI and/or Death b) A normal study has a very high negative predictive value c) The presence of an old MI is of little predictive value for perioperative MI or cardiac death
20 Preoperative Coronary Revascularization Class I : Revascularization is recommended in circumstances in which it is indicated according to CPGs (LOE: C) a) If Evaluation recommends Surgical revascularization (CABG) Go for it! b) Percutaneous Revascularization should be considered for 1) Left Main Disease in poor surgical candidates 2) Unstable CAD 3) NSTEMI/STEMI consider POBA/BMS Class III : Routine Revascularization before non cardiac surgery is not recommended (LOE: B)
21 Timing of Elective Surgery (post PCI) Class I : a) POBA : 2 weeks (LOE: C) b) BMS : 4 weeks (LOE: B) c) DES : 1 year (LOE: B) Class IIB : Elective Surgery after DES may be considered after 180 days if the risk of further delay is greater than the expected risks of Ischemia and Stent Thrombosis (LOE: B)
22 Perioperative Beta Blocker (BB) Therapy Class I : BBs should be continued perioperatively for those who have been on it chronically (LOE: B) Class II B : BB can be initiated in the following settings; 1) Intermediate or High Risk Myocardial Ischemia prior to the procedure (LOE: C) 2) 3 or more RCRI risk factors (LOE: B)
23 Timing of Initiation: 2 7 days before the procedure Class III : BB therapy SHOULD NOT BE STARTED ON THE DAY OF SURGERY
24 Perioperative Statin Therapy Class I : Statins should be continued perioperatively for those who have been on it chronically (LOE: B) Class IIA : Statins can be considered in those undergoing Vascular Surgery (LOE: B)
25 Perioperative Aspirin (ASA) Therapy Class III : Initiation or continuation of ASA is not beneficial in patients undergoing non cardiac or non carotid surgery, who have not had previous stenting, unless the risk of Ischemic events outweigh the risks of surgical bleeding (LOE: C)
26 Sample Notes The patient is at Low perioperative risk for major adverse cardiac events (< 1% risk for Death and non fatal MI). No further cardiac testing is indicated at this time. To proceed to Surgery, continue BB and Statin therapy perioperatively. The patient is at Elevated perioperative risk for major adverse cardiac events (greater than or equal to 1% risk for Death and non fatal MI). However, further cardiac testing is unlikely to impact decision making or care, and is therefore not indicated at this time. To proceed to Surgery, continue BB and Statin therapy perioperatively. The patient is at Elevated perioperative risk for major adverse cardiac events (greater than or equal to 1% risk for Death and non fatal MI). To order a Cardiac Stress Test prior to the procedure for further risk stratification.
27 Question 1 81 Y/O AAM with a H/O CAD S/P CABG (1985), PAD S/P PTA to the Right SFA (2013), DM, HTN, Hyperlipidemia, CKD Stage 4 and CVA (2008) with no residual neurological deficits is about to undergo Cataract Surgery. His Ophthalmologist calls you for Preoperative Evaluation. Low Risk for MACE. Proceed with Surgery
28 Question 2 56 Y/O WM with a H/O CAD S/P PCI to the LAD (2014), DM, HTN and Hyperlipidemia is about to undergo Right Inguinal Herniorrhaphy. He however, gives a history of worsening chest pain (similar to the pain he experienced prior to his Stent Placement) over the last 2 weeks. Physical Exam reveals a Right Inguinal Hernia without signs of Incarceration. His Surgeon wants to know if he could proceed with the procedure. Unstable Angina the heart comes first!
29 Question 3 45 Y/O AAF with a H/O DM and HTN who was admitted for elective Hiatal Hernia repair. She develops chest pain soon after admission, and an EKG revealed Lateral ST depressions concerning for Ischemia. Cardiac Enzymes showed an elevated troponin of 2 ng/ml. She wants to go ahead with the planned procedure, and the surgeon seeks your help. NSTEMI Left heart catheterization and possible PCI!!!!
30 Question 4 65 Y/O WM with a H/O DM (on Metformin), HTN and Hyperlipidemia who was referred to the Cardiology Clinic for Preoperative Evaluation prior to Lumbar Laminectomy. Low Risk for MACE. Proceed with Surgery
31 Question 5 31 Y/O WM with no significant PMH comes to the ED with C/O intense RLQ Abdominal Pain. He was subsequently diagnosed with Acute Appendicitis. The first year surgical resident calls you for preoperative evaluation. Be Nice!!!!! Proceed to surgery.
32 Question 6 Dr Gill from the VA Medical Center calls you about a 65 Y/O AAM with a H/O CAD S/P PCI to the LAD (2010), Ischemic Cardiomyopathy (EF of 35% per 2 D ECHO), DM, CKD Stage 3 (Creatinine of 2.1 mg/dl), HTN and Hyperlipidemia who presented for an elective Right Carotid Endarterectomy, and was not cleared by Cardiology. He is asymptomatic from a cardiac standpoint, and can climb a flight of stairs without discomfort. He is currently on ASA, Metoprolol, Lisinopril, Simvastatin and Insulin. Proceed to surgery. Continue ASA, BB and Statin therapy
33 Question 7 Part 1 75 Y/O WM with a H/O CAD S/P PCI to the LAD (2009), CVA (2010) with residual left sided weakness, DM (requiring Insulin), HTN and Hyperlipidemia who is about to undergo a Left Great Toe Amputation for a chronic non healing ulcer. His functional capacity is extremely limited due to his Stroke. The vascular surgeon would like you to evaluate his cardiac risk prior to the procedure. Cardiac Stress Test
34 Part 2 The patient however refuses to undergo Bypass Surgery or PCI should the Cardiac Stress Test reveal abnormalities. He just wants this darn toe off. Proceed to Surgery with GDMT
35 Part 3 He speaks to his wife the next day, and suddenly has a change of heart. He is willing to undergo Coronary Angiography and further therapy for the same should it be indicated. The Cardiac Stress Test reveals a large reversible perfusion defect in the anterior wall and the apex. He subsequently undergoes Coronary Angiography, which reveals critical Left Main Disease. Consult Cardiothoracic Surgery!
36 Thank You!!!
8/28/2018. Pre-op Evaluation for non cardiac surgery. A quick review from 2007!! Disclosures. John Steuter, MD. None
Pre-op Evaluation for non cardiac surgery John Steuter, MD Disclosures None A quick review from 2007!! Fliesheret al, ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and are for Noncardiac
Perioperative Cardiology Consultations for Noncardiac Surgery Ischemic Heart Disease
2012 대한춘계심장학회 Perioperative Cardiology Consultations for Noncardiac Surgery Ischemic Heart Disease 울산의대울산대학병원심장내과이상곤 ECG CLASS IIb 1. Preoperative resting 12-lead ECG may be reasonable in patients with
Preoperative Risk. Geoffrey C Zarrella DO FACC. Assessment
Preoperative Risk Geoffrey C Zarrella DO FACC Assessment your late add ons keep calm use your tools stick to your guns PURPOSE OF THE PREOP EVAL ASSESS PERIOP RISK CAN INFORM DECISION TO PROCEED OR
Assessing Cardiac Risk in Noncardiac Surgery. Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington
Assessing Cardiac Risk in Noncardiac Surgery Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington Disclosure None. I have no conflicts of interest, financial or otherwise. CME
Perioperative Cardiac Management. Emma Sargsyan, MD, FACP
Perioperative Cardiac Management Emma Sargsyan, MD, FACP March 22-24, 2018 Outline Evaluation of cardiac risk prior to non-cardiac surgery Management of cardiac risk for non-cardiac surgery 2 Preop medical
Perioperative Cardiovascular Evaluation and Care for Noncardiac. Dr Mahmoud Ebrahimi Interventional cardiologist 91/9/30
Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery Dr Mahmoud Ebrahimi Interventional cardiologist 91/9/30 Active Cardiac Conditions for Which the Patient Should Undergo Evaluation
Cardiac evaluation for the noncardiac. Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology
Cardiac evaluation for the noncardiac patient Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology Objectives! Review ACC / AHA guidelines as updated for 2009! Discuss new recommendations
Evaluation and Management of the Patient with Cardiac Disease for Non-Cardiac Surgery WINTER CONFRENCE 2016 RONY GORGES, MD
Evaluation and Management of the Patient with Cardiac Disease for Non-Cardiac Surgery WINTER CONFRENCE 2016 RONY GORGES, MD 67 yo man Asymptomatic carotid stenosis, CEA planned Golfs regularly, walks and
Timing of Surgery After Percutaneous Coronary Intervention
Timing of Surgery After Percutaneous Coronary Intervention Deepak Talreja, MD, FACC Bayview/EVMS/Sentara Outline/Highlights Timing of elective surgery What to do with medications Stopping anti-platelet
COMPARISON OF 2014 ACCAHA VS. ESC GUIDELINES EDITORIAL
COMPARISON OF 2014 ACCAHA VS. ESC GUIDELINES EDITORIAL Guidelines in review: Comparison of the 2014 ACC/AHA guidelines on perioperative cardiovascular evaluation and management of patients undergoing noncardiac
Preoperative Evaluation Guidelines and Work up
Preoperative Evaluation Guidelines and Work up Wesley Fiser, MD Disclosures: None 1 Case An 80 year old woman with osteoarthritis of the hip, DM, CKD (Cr 2.1), and HTN is diagnosed with an obstructing
Clinical Controversies in Perioperative Medicine
Clinical Controversies in Perioperative Medicine Hugo Quinny Cheng, MD Division of Hospital Medicine University of California, San Francisco Cardiac Evaluation: New Guidelines A 70-y.o. man with progressive
Pre-op Risk Assessment. Hal Blanks MD FACC
Pre-op Risk Assessment Hal Blanks MD FACC Objectives: Identify and manage patients with known or suspected CAD and other cardiac diseases who are at risk of cardiac complications during noncardiac surgery.
Preoperative Evaluation of Patients Undergoing Noncardiac Surgery
Preoperative Evaluation of Patients Undergoing Noncardiac Surgery Shazia Khan, MD Assistant Professor of Clinical Medicine Keck School of Medicine LAC+USC Medical Center Learning Objectives Use a risk
PERIOPERATIVE CARDIAC RISK ASSESSMENT. Divya Gollapudi, MD
PERIOPERATIVE CARDIAC RISK ASSESSMENT Divya Gollapudi, MD Clinical Assistant Professor Hospital Medicine Program Division of General Internal Medicine Harborview Medical Center None Disclosures Objectives
Conflicts of Interest. Evaluation of Cardiac and Pulmonary Risk in the Preop Patient. Introduction. Risk Assessment. Risk Assessment: RCRI
Evaluation of Cardiac and Pulmonary Risk in the Preop Patient Conflicts of Interest I have no conflicts of interest to declare Adam Schaffer, MD Brigham and Women s Hospital July 20, 2012 Introduction
Perioperative Medicine 2016 Some Answers, Even More Questions
Learning Objectives Perioperative Medicine 2016 Some Answers, Even More Questions Kurt Pfeifer, MD, FACP, FHM Professor of Medicine Medical College of Wisconsin Outline changes to the ACC/AHA perioperative
Non ST Elevation-ACS. Michael W. Cammarata, MD
Non ST Elevation-ACS Michael W. Cammarata, MD Case Presentation 65 year old man PMH: CAD s/p stent in 2008 HTN HLD Presents with chest pressure, substernally and radiating to the left arm and jaw, similar
Cardiac Risk Assessment in the Preoperative period
Cardiac Risk Assessment in the Preoperative period Catherine Curley, MD May, 2017 Disclosures I am not a cardiologist! 1 Case 1 78 yo man presenting to the ED after mechanical fall on his driveway. Found
David A. Orsinelli, MD, FACC, FASE Professor, Internal Medicine The Ohio State University Division of Cardiovascular Medicine Columbus, Ohio
1 STABLE ISCHEMIC HEART DISEASE: A NON-INVASIVE CARDIOLOGIST S PERSECTIVE 2018 Cardiovascular Course for Trainees and Early Career Physicians APRIL 20, 2018 David A. Orsinelli, MD, FACC, FASE Professor,
Preoperative Cardiac Evaluation:
Preoperative Cardiac Evaluation: The New Guidelines Hugo Quinny Cheng, MD Division of Hospital Medicine University of California, San Francisco Disclosures No financial relationships with pharmaceutical
4/27/2015. Cardiac Events #1 cause of postoperative complications/ mortality- CHF, complete heart block, MI,
Not intended for medical clearance Identify, document, and evaluate health conditions Medication Management Stratify Risks Optimize conditions within context of surgical illness Recommend measures that
DIFFERENTIATING THE PATIENT WITH UNDIFFERENTIATED CHEST PAIN
DIFFERENTIATING THE PATIENT WITH UNDIFFERENTIATED CHEST PAIN Objectives Gain competence in evaluating chest pain Recognize features of moderate risk unstable angina Review initial management of UA and
Indications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014
Indications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014 Indications for cardiac catheterization Before a decision to perform an invasive procedure such
2018 David Stultz. The Consultant s Job
The Consultant s Job Cardiac Pre-Operative Evaluation ACC 2014 Guidelines David Stultz, MD September 8, 2017 www.drstultz.com KPN Heart & Vascular Objectives of Conference Understand Cardiac Clearance
Perioperative Assessment in the Older Adult. Sondra Vazirani, MD, MPH
Perioperative Assessment in the Older Adult Sondra Vazirani, MD, MPH The Preoperative Evaluation in the Older Adult Sondra Vazirani, MD, MPH, FACP* 33 rd UCLA Intensive Course in Geriatric Medicine & Pharmacy,
Management of Stable Ischemic Heart Disease. Vinay Madan MD February 10, 2018
Management of Stable Ischemic Heart Disease Vinay Madan MD February 10, 2018 1 Disclosure No financial disclosure. 2 Overview of SIHD Diagnosis Outline of talk Functional vs. Anatomic assessment Management
Learning Objectives. Epidemiology of Acute Coronary Syndrome
Cardiovascular Update: Antiplatelet therapy in acute coronary syndromes PHILLIP WEEKS, PHARM.D., BCPS-AQ CARDIOLOGY Learning Objectives Interpret guidelines as they relate to constructing an antiplatelet
Guidelines PATHOLOGY: FATAL PERIOPERATIVE MI NON-PMI N = 25 PMI N = 42. Prominent Dutch Cardiovascular Researcher Fired for Scientific Misconduct
PATHOLOGY: FATAL PERIOPERATIVE MI NON-PMI N = 25 PMI N = 42 Preoperative, Intraoperative, and Postoperative Factors Associated with Perioperative Cardiac Complications in Patients Undergoing Major Noncardiac
Update in Perioperative Medicine
Update in Perioperative Medicine Linda Venner MD FACP March 2018 Agenda 1 2 3 4 5 Optimized not Cleared Identify red flags for cardiac and pulmonary complications Optimize management Prevent delirium Don
Surgical vs. Percutaneous Revascularization in Patients with Diabetes and Acute Coronary Syndrome
Surgical vs. Percutaneous Revascularization in Patients with Diabetes and Acute Coronary Syndrome Chris C. Cook, MD Associate Professor of Surgery Director, CT Residency Program, WVU ACOI 10/17/18 No Disclosures
Objectives. Old School. Preoperative Evaluation and Postoperative Complications: Where are the opportunities for risk reduction?
Preoperative Evaluation and Postoperative Complications: Where are the opportunities for risk reduction? Jeffrey Carter, MD RMHMS October 5, 2010 Objectives Understand the preoperative cardiac evaluation
D M Y Y Y Y D D M M Y Y Y Y. Previous MI (apart from acute PCI) 0=no 1=yes 9=unknown
I Patient details and Preoperative Data Date of Informed Consent dd-mm-yyyy (Please leave blank if waived by Ethics Committee) Please enter Patient ID in this format xxx-xx-xxx 3 digit code for the country,
Preoperative Evaluation of CABG Patient Needing Non- Cardiac Surgery. Scott Davis, M.D., F.A.C.C. BHHI Primary Care Symposium February 26, 2016
Preoperative Evaluation of CABG Patient Needing Non- Cardiac Surgery Scott Davis, M.D., F.A.C.C. BHHI Primary Care Symposium February 26, 2016 DISCLOSURES Gilead Boston Scientific I. The Components of
Pre-operative Evaluations. Objectives. General Considerations. FP Consultation Considerations. CV Credits 7/24/2017. Brian Bachelder, MD Akron, Ohio
Pre-operative Evaluations Brian Bachelder, MD Akron, Ohio Objectives Discuss the perioperative cardiopulmonary evaluation and management of patients undergoing non-cardiac surgery Objectively estimate
Clinical Controversies in Perioperative Medicine
Clinical Controversies in Perioperative Medicine Hugo Quinny Cheng, MD Division of Hospital Medicine University of California, San Francisco Predicting & Managing Cardiac Risk A 70-y.o. man with progressive
Coronary Artery Disease: Revascularization (Teacher s Guide)
Stephanie Chan, M.D. Updated 3/15/13 2008-2013, SCVMC (40 minutes) I. Objectives Coronary Artery Disease: Revascularization (Teacher s Guide) To review the evidence on whether percutaneous coronary intervention
Pre-Operative Services Teaching Rounds 3 Jan 2011
Pre-Operative Services Teaching Rounds 3 Jan 2011 Deborah Richman MBChB FFA(SA) Director Pre-Operative Services Department of Anesthesia Stony Brook University Medical Center, NY drichman@notes.cc.sunysb.edu
Agenda. Perioperative Cardiac Risk Stratification circa Surgical Mortality: What is High Risk? Presenter Disclosure Information
9:45 1:45 am Perioperative Evaluation and Management of the Cardiac Patient in Noncardiac Surgery SPEAKER Joshua A. Beckman, MD, MS Presenter Disclosure Information The following relationships exist related
Perioperative Medical Therapy: Beta Blockers, Statins, ACE-Inhibitors, ARB Effects on Mortality
Perioperative Medical Therapy: Beta Blockers, Statins, ACE-Inhibitors, ARB Effects on Mortality Art Wallace, MD, PhD SF VAMC Chief of Anethesia and Vice Chair of Anesthesia and Perioperative Care UCSF
John B. Hill D.O. Department of Anesthesiology NORMAN ANESTHESIA PROVIDERS 03/05/2013
Pre-op Assessment by Primary Providers What we really want to know John B. Hill D.O. Department of Anesthesiology NORMAN ANESTHESIA PROVIDERS 03/05/2013 Outline Discuss anesthesia specific risk Discuss
Cardiac Risk Factors and Noninvasive Cardiac Diagnosis-ECG, ECHO, et al. Martin C. Burke, DO, FACOI ACOI IM Board Review Course 2018
Cardiac Risk Factors and Noninvasive Cardiac Diagnosis-ECG, ECHO, et al. Martin C. Burke, DO, FACOI ACOI IM Board Review Course 2018 No Disclosures The American Heart Association Evidence-Based Scoring
Interventions in the Elderly
Interventions in the Elderly Satya Reddy Atmakuri MD FIFTH ANNUAL SYMPOSIUM I Have No Financial Interest to Disclose People greater than 65 years of age will increase from 12% of population in 2000 to
Controversies in Cardiac Pharmacology
Controversies in Cardiac Pharmacology Thomas D. Conley, MD FACC FSCAI Disclosures I have no relevant relationships with commercial interests to disclose. 1 Doc, do I really need to take all these medicines?
2/17/2010. Grace Lin, MD Assistant Professor of Medicine University of California, San Francisco
Modern Management of Patients with Stable Coronary Artery Disease Grace Lin, MD Assistant Professor of Medicine University of California, San Francisco Scope of the Problem Prevalence of CAD: 17.6 million
Acute Coronary Syndrome. Sonny Achtchi, DO
Acute Coronary Syndrome Sonny Achtchi, DO Objectives Understand evidence based and practice based treatments for stabilization and initial management of ACS Become familiar with ACS risk stratification
DUKECATHR Dataset Dictionary
DUKECATHR Dataset Dictionary Version of DUKECATH dataset for educational use that has been modified to be unsuitable for clinical research or publication (Created Date and Time: 28OCT16 14:35) Table of
Cardiac Perioperative Risk Assessment American Heart Association Guidelines
Cardiac Perioperative Risk Assessment American Heart Association Guidelines Dr Gary Liew, MBBS, PhD, FRACP US Board Certified in Cardiovascular CT Executive Committee, Cardiac Institute, Epworth Healthcare
HEART AND SOUL STUDY OUTCOME EVENT - MORBIDITY REVIEW FORM
REVIEW DATE REVIEWER'S ID HEART AND SOUL STUDY OUTCOME EVENT - MORBIDITY REVIEW FORM : DISCHARGE DATE: RECORDS FROM: Hospitalization ER Please check all that may apply: Myocardial Infarction Pages 2, 3,
APPENDIX F: CASE REPORT FORM
APPENDIX F: CASE REPORT FORM Instruction: Complete this form to notify all ACS admissions at your centre to National Cardiovascular Disease Registry. Where check boxes are provided, check ( ) one or more
SESSION 5 2:20 3:35 pm
SESSION 2:2 3:3 pm Strategies to Reduce Cardiac Risk for Noncardiac Surgery SPEAKER Lee A. Fleisher, MD Presenter Disclosure Information The following relationships exist related to this presentation:
PERIOPERATIVE EVALUATION. Brenda Shinar, MD
PERIOPERATIVE EVALUATION Brenda Shinar, MD Case 1 Your 75 year-old mother calls in a panic to tell you that she has hurt her knee and cannot bear weight due to excruciating pain. She was doing some stretches,
6/1/18 LEARNING OBJECTIVES PATIENT POPULATION PRESENTATIONS
PREVENTING HOSPITAL READMISSIONS IN CARDIOVASCULAR PATIENTS Christina Cortez Perry, MSN, FNP-C, CCCC Cardiology Coordinator- Corpus Christi Medical Center 1 2 LEARNING OBJECTIVES Identify the target patient
Update on Perioperative Medicine. Update on Perioperative Medicine. Question 1: Clinical Risk Prediction. for the Office-based Practitioner
Update on Perioperative Medicine Update on Perioperative Medicine for the Office-based Practitioner Hugo Quinny Cheng, MD Division of Hospital Medicine University of California, San Francisco Predicting
Disclosures. Inpatient Management of Non-ST Elevation Acute Coronary Syndromes. Edward McNulty MD, FACC. None
Inpatient Management of Non-ST Elevation Acute Coronary Syndromes Edward McNulty MD, FACC Assistant Clinical Professor UCSF Director, SF VAMC Cardiac Catheterization Laboratory Disclosures None New Guidelines
Chest Pain: To Cath or Not? Part I
Chest Pain: To Cath or Not? Part I Georgios Papaioannou, MD Ioannis Karavas, MD Newton-Wellesley Hospital 5/3/2000 1 A Typical Scenario... 57 year old female, Mrs. X., presents to your office with a 2
A few years ago my team was consulted to clear a patient for surgery. I said OK, let s get a pre-op consult note on the chart.
November 2016 A few years ago my team was consulted to clear a patient for surgery. I said OK, let s get a pre-op consult note on the chart. He consulted Cardiology. No attempt should be made to prognosticate
Women and Vascular Disease
Women and Vascular Disease KEVIN F. REBECK PA-C VASCULAR TRANSPLANT SURGERY 1 The Scope of the Problem One woman dies every minute from cardiovascular disease in the U.S.! The Scope of the Problem CVD
Stress Echocardiography: Illustrative Cases Sunil Mankad, MD, FACC, FCCP, FASE Associate Professor of Medicine Mayo Clinic College of Medicine Director, Transesophageal Echocardiography Associate Director,
Anesthesia for Cardiac Patients for Non Cardiac Surgery. Kimberly Westra DNP, MSN, CRNA
Anesthesia for Cardiac Patients for Non Cardiac Surgery Kimberly Westra DNP, MSN, CRNA Anesthesia for Cardiac Patients for Non Cardiac Surgery Heart Disease is a significant problem in the United States:
Dr Kerry Gunn. Dr Nicola Broadbent. Anaesthesiologist Auckland City Hospital Auckland. Specialist Anaesthetist Auckland City Hospital Auckland
Dr Kerry Gunn Anaesthesiologist Auckland City Hospital Auckland Dr Nicola Broadbent Specialist Anaesthetist Auckland City Hospital Auckland 8:30-9:25 WS #96: Optimising Patients for Surgery - Defining
AMERICAN SOCIETY OF ANESTHESIOLOGISTS ANESTHESIA PRE OPERATIVE SCREENING ASA PHYSICAL STATUS CLASSIFICATION ANESTHESIOLOGISTS
ANESTHESIA PRE OPERATIVE SCREENING CAPA S 37 TH ANNUAL CONFERENCE PALM SPRINGS OCTOBER 5, 2013 ROBERT F. KOPEL, MD, FACP, FCCP HOAG HOSPITAL ASSISTANT CLINICAL PROFESSOR UCLA SCHOOL OF MEDICINE AMERICAN
Evaluating the Heart before Non-Cardiac Surgery
Evaluating the Heart before Non-Cardiac Surgery Dr Rob Stephens Anaesthetist UCLH + UCL the centre for Anaesthesia www.ucl.ac.uk/anaesthesia/people/stephens Google UCL Stephens www.ucl.ac.uk/anaesthesia/people/stephens
Stable Angina: Indication for revascularization and best medical therapy
Stable Angina: Indication for revascularization and best medical therapy Cardiology Basics and Updated Guideline 2018 Chang-Hwan Yoon, MD/PhD Cardiovascular Center, Department of Internal Medicine Bundang
WHI Form Report of Cardiovascular Outcome Ver (For items 1-11, each question specifies mark one or mark all that apply.
WHI Form - Report of Cardiovascular Outcome Ver. 6. COMMENTS To be completed by Physician Adjudicator Date Completed: - - (M/D/Y) Adjudicator Code: OMB# 095-044 Exp: 4/06 -Affix label here- Clinical Center/ID:
Perioperative Medicine 2017 November 3, Disclosures
Perioperative Medicine 2017 November 3, 2017 Scott Marsal, MD MSc FACP Chief, Medicine Division Medical Director, Quality & Patient Safety Providence St. Vincent Medical Center Disclosures No conflicts
Acute Myocardial Infarction
Acute Myocardial Infarction Hafeza Shaikh, DO, FACC, RPVI Lourdes Cardiology Services Asst.Program Director, Cardiology Fellowship Associate Professor, ROWAN-SOM Acute Myocardial Infarction Definition:
Clinical Controversies in Perioperative Medicine
Update on Perioperative Medicine Clinical Controversies in Perioperative Medicine Hugo Quinny Cheng, MD Division of Hospital Medicine University of California, San Francisco Cardiac Medications & Perioperative
Screening for Asymptomatic Coronary Artery Disease: When, How, and Why?
Screening for Asymptomatic Coronary Artery Disease: When, How, and Why? Joseph S. Terlato, MD FACC Clinical Assistant Professor, Brown Medical School Coastal Medical Definition The presence of objective
Coronary interventions
Controversial issues in the management of ischemic heart failure Coronary interventions Maciej Lesiak Department of Cardiology, University Hospital in Poznan none DECLARATION OF CONFLICT OF INTEREST CHF
I have no disclosures
Preparing patients for out of hospital anesthesia BobbieJean Sweitzer, M.D. Director, Anesthesia Perioperative Medicine Clinic Professor of Anesthesia and Critical Care Professor of Medicine University
AAA CAG CAG. ACC / AHA Guidelines for Perioperative Cardiovascular Evaluation for Noncardiac. Group Group AAA AAA.
13 591 596 2004 AAA CAG CAG 5527 15 CAG ACC / AHA Guidelines for Perioperative Cardiovascular Evaluation for Noncardiac Surgery CAG 55 34 62CAG 75 CAG 73 63 66 ACC / AHA CAGGroup 1 9 8 Group 225 22 Group
When Should I Order a Stress Test or an Echocardiogram
When Should I Order a Stress Test or an Echocardiogram Updates in Cardiology 2015 March 7, 2015 Donald L. Lappé, MD, FAHA, FACC Chairman, Cardiovascular Department Medical Director, Intermountain Cardiovascular
Acute Coronary Syndrome. Cindy Baker, MD FACC Director Peripheral Vascular Interventions Division of Cardiovascular Medicine
Acute Coronary Syndrome Cindy Baker, MD FACC Director Peripheral Vascular Interventions Division of Cardiovascular Medicine Topics Timing is everything So many drugs to choose from What s a MINOCA? 2 Acute
Dual Antiplatelet Therapy Made Practical
Dual Antiplatelet Therapy Made Practical David Parra, Pharm.D., FCCP, BCPS Clinical Pharmacy Program Manager in Cardiology/Anticoagulation VISN 8 Pharmacy Benefits Management Clinical Associate Professor
10/22/16. Lay of the land. Definition of ACS. Why do we worry about ST elevations?
Lay of the land Update on Acute Coronary Syndrome: Five Things Hospitalists Must Know Dhruv S. Kazi, MD, MSc, MS Assistant Professor Department of Medicine (Cardiology), Department of Epidemiology and
An update on the management of UA / NSTEMI. Michael H. Crawford, MD
An update on the management of UA / NSTEMI Michael H. Crawford, MD New ACC/AHA Guidelines 2007 What s s new in the last 5 years CT imaging advances Ascendancy of troponin and BNP Clarification of ACEI/ARB
Lessons learned From The National PCI Registry
Lessons learned From The National PCI Registry w a v e On Behalf of The Publication Committee of the National PCI Registry Objectives & Anticipated Achievements To determine the epidemiology of patients
Case Study 50 YEAR OLD MALE WITH UNSTABLE ANGINA
Case Study 50 YEAR OLD MALE WITH UNSTABLE ANGINA Case History A 50-year-old man with type 1 diabetes mellitus and hypertension presents after experiencing 1 hour of midsternal chest pain that began after
PERIOPERATIVE EVALUATION AND ANESTHETIC MANAGEMENT OF PATIENTS WITH CARDIAC DISEASE FOR NON CARDIAC SURGERY
PERIOPERATIVE EVALUATION AND ANESTHETIC MANAGEMENT OF PATIENTS WITH CARDIAC DISEASE FOR NON CARDIAC SURGERY WHICH PATIENT IS AT HIGHEST RISK? 1. 70 yo asymptomatic patient with history of heart failure
Chest pain and troponins on the acute take. J N Townend Queen Elizabeth Hospital Birmingham
Chest pain and troponins on the acute take J N Townend Queen Elizabeth Hospital Birmingham 3 rd Universal Definition of Myocardial Infarction Type 1: Spontaneous MI related to atherosclerotic plaque rupture
Evidence-Based Management of CAD: Last Decade Trials and Updated Guidelines
Evidence-Based Management of CAD: Last Decade Trials and Updated Guidelines Enrico Ferrari, MD Cardiac Surgery Unit Cardiocentro Ticino Foundation Lugano, Switzerland Conflict of Interests No conflict
PERIOPERATIVE MYOCARDIAL INFARCTION THE ANAESTHESIOLOGIST'S VIEW
PERIOPERATIVE MYOCARDIAL INFARCTION THE ANAESTHESIOLOGIST'S VIEW Bruce Biccard Perioperative Research Group, Department of Anaesthetics 18 June 2015 Disclosure Research funding received Medical Research
Choosing the Appropriate Stress Test: Brett C. Stoll, MD, FACC February 24, 2018
Choosing the Appropriate Stress Test: Brett C. Stoll, MD, FACC February 24, 2018 Choosing the Appropriate Stress Test: Does it Really Matter? Brett C. Stoll, MD, FACC February 24, 2018 Conflicts of Interest
2/26/2013. Appropriateness Use Criteria (Drilldown) Disclosures. Tony Hermann has nothing to disclose. Mark Hutcheson has nothing to disclose
Appropriateness Use Criteria (Drilldown) Disclosures Tony Hermann has nothing to disclose Mark Hutcheson has nothing to disclose Connie Anderson has nothing to disclose Issam Moussa has nothing to disclose
Imaging ischemic heart disease: role of SPECT and PET. Focus on Patients with Known CAD
Imaging ischemic heart disease: role of SPECT and PET. Focus on Patients with Known CAD Hein J. Verberne Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands International Conference
To provide information on the use of acetyl salicylic acid in the treatment and prevention of vascular events.
ACETYL SALICYLIC ACID TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: To provide information on the use of acetyl salicylic acid in the treatment and prevention of vascular events.
Use of Nuclear Cardiology in Myocardial Viability Assessment and Introduction to PET and PET/CT for Advanced Users
Use of Nuclear Cardiology in Myocardial Viability Assessment and Introduction to PET and PET/CT for Advanced Users February 1 5, 2011 University of Santo Tomas Hospital Angelo King A-V Auditorium Manila,
ARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM. General Instructions: ID NUMBER: FORM NAME: H F A DATE: 10/13/2017 VERSION: CONTACT YEAR NUMBER:
ARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM General Instructions: The Heart Failure Hospital Record Abstraction Form is completed for all heart failure-eligible cohort hospitalizations. Refer to
Acute Myocardial Infarction. Willis E. Godin D.O., FACC
Acute Myocardial Infarction Willis E. Godin D.O., FACC Acute Myocardial Infarction Definition: Decreased delivery of oxygen and nutrients to the myocardium Myocardial tissue necrosis causing irreparable
2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease
2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease Developed in Collaboration with American Association for Thoracic Surgery, American
Detailed Order Request Checklists for Cardiology
Next Generation Solutions Detailed Order Request Checklists for Cardiology 8600 West Bryn Mawr Avenue South Tower Suite 800 Chicago, IL 60631 www.aimspecialtyhealth.com Appropriate.Safe.Affordable 2018
Controversies in Perioperative Medicine
Controversies in Perioperative Medicine Staying Abreast & Ahead of the Guidelines Hugo Quinny Cheng, MD Division of Hospital Medicine University of California, San Francisco Controversies in Perioperative
2010 ACLS Guidelines. Primary goals of therapy for patients
2010 ACLS Guidelines Part 10: Acute Coronary Syndrome Present : 內科 R1 鍾伯欣 Supervisor: F1 吳亮廷 991110 Primary goals of therapy for patients of ACS Reduce the amount of myocardial necrosis that occurs in
Agenda. Disclosures. Surgical Mortality: What is High Risk?
Pre-Operative Cardiac Evaluation of the Vascular Patient: Updated AHA/ACC Guidelines Choosing Wisely UCSF Vascular Symposium 2015 Joshua A. Beckman, M.D., M.S. Brigham and Women s Hospital Consulting Merck
Data Elements and Definitions with Case Studies. Interpreting Your Outcomes Reports. Kim Hustler, Clinical Quality Consultant, NCDR
Data Elements and Definitions with Case Studies Interpreting Your Outcomes Reports Kim Hustler, Clinical Quality Consultant, NCDR Beth Pruski, Program Manager, NCDR The following relationships exist: Beth
Difficult Data Definitions and Scenario s
Difficult Data Definitions and Scenario s Presenter Disclosure Information Cornelia Anderson BSN, RN To following relationships exist related to this presentation: No Disclosures Objectives Discuss key
PRE Operative Care of the High Risk Surgical Patient. Dr A T Dewhurst Consultant Anaesthetist St George s Hospital London
PRE Operative Care of the High Risk Surgical Patient Dr A T Dewhurst Consultant Anaesthetist St George s Hospital London Perioperative Optimization Shoemaker oxygen delivery goal directed therapy ITS NOT
An algorithmic approach to the very high risk surgical patient
An algorithmic approach to the very high risk surgical patient Daniel A. Reuter Center of Anesthesiology and Intensive Care Medicine Hamburg-Eppendorf Universiy Medical Center Disclosures: Member of the
ESC GUIDELINES ON DIABETES AND CARDIOVASCULAR DISEASES
ESC GUIDELINES ON DIABETES AND CARDIOVASCULAR DISEASES Pr. Michel KOMAJDA Institute of Cardiology - IHU ICAN Pitie Salpetriere Hospital - University Pierre and Marie Curie, Paris (France) DEFINITION A