Prevention Of Cardiac Ischemia In The Surgical Patient - California ...

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Types of MIs • Two types of heart attacks (First criterion): • Anterior infarct. • Most dangerous type of MI • Caused by a blockage in the branch of the LCA • Affects LV which pumps blood to all parts of the body and damages the front part of the heart. • Posterior or inferior infarct • Less serious • Caused by a blockage in the RCA or one of its branches • Affects the back or the base of the heart. 18
Types of MIs • According to the second criterion • ST segment elevation MI (STEMI). • Caused by prolonged period of blocked blood supply • Affects a large portion of the myocardium • Causes significant changes on EKG & in blood chemical markers • Non-ST segment elevation MI (NSTEMI) • Caused by a partial or temporary blockage in blood supply • Extent of damage is minimal • No changes on EKG but blood markers indicate MI 19
Page 1 and 2: Prevention of Cardiac Ischemia in t
Page 3 and 4: Case Study • 85-year-old, 50-kg f
Page 5 and 6: Heart Disease & Smoking • Smokers
Page 7 and 8: Heart Disease and Surgery • Of th
Page 9 and 10: Anesthesia and Ischemia
Page 11 and 12: Sensitivity to Detect Ischemia •
Page 13 and 14: How healthy is the patient? Good LV
Page 15 and 16: Impaired LV Function • EF < 40%
Page 17: Perioperative Myocardial Ischemia
Page 21 and 22: Anesthetic Goal Reduce the incidenc
Page 23 and 24: Anesthetic Choice • Each type of
Page 25 and 26: Importance of Prevention A single e
Page 27 and 28: Balance Supply & Demand • Increas
Page 29 and 30: Alpha 2 Adrenergic Agonists • Clo
Page 31 and 32: Calcium Channel Blockers • Arteri
Page 33 and 34: Selective Beta Blockers • Beta bl
Page 35 and 36: What about the use of beta blockers
Page 37 and 38: ACC/AHA 2004 Perioperative Guidelin
Page 39 and 40: POISE Study • In the Toprol group
Page 41 and 42: Advice on Beta Blockers • Continu
Page 43 and 44: 2007 STEMI Recommendations • Risk
Page 45 and 46: Treatment of Ischemia • Morphine
Page 47 and 48: Patient with a Cardiac Stent • Si
Page 49 and 50: When Surgery cannot be Postponed an
Page 51 and 52: Case Study #1 • 70 year old male,
Page 53 and 54: Should surgery proceed?
Page 55 and 56: Case Study #2 • Surgery postponed
Page 57 and 58: Case Study #3 • 52 yr old female
Page 59 and 60: Case Study #5 • 74 year-old, 86 k
Page 61 and 62: Summary: Bare Metal Stents • Dela

Prevention Of Cardiac Ischemia In The Surgical Patient - California ...

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