Coronary artery disease patient for non cardiac surgery

Scenario

Mrs. Saroja, 66y

Planne for open ventral hernia mesh repair

Asa 3 – knwn Dm,htn both poorly controlled ,non compliance to drugs , Hypothyroid on Tab.eltrox 25mcg .

Clinical examination

General condition : moderately built , Vitals: BP – 170/90mmhg,others wnl Airway : mallampati grade 2,short neck . Systemic : chest clear .

Blood reports : all normal limits except poor glycemic profile and baseline creatinine 1.7, Ecg: strain pattern +,lvh ,Lbbb

Echo: Ef:55%, RWMA + of LV.

Chest xray : normal

PREOP RISK SRATIFICATION AND OPTIMIZATION

1. cardiologist consult
2. physician consult for glycemic control
3. Multidisciplinary approach
4. Optimization of cardiac pathology prior to non cardiac sx

Further evalution , cardiologist advised

1.CAG

Which showed LAD 80% stenosis ,with poor collaterals LCX 70% stenosis ,

RCA :

Pt was advised to undergo immediate PCI WITH PTCA followed by oral antiplatelets .

RISK ASSESMENT SCORES IN CARDIAC PATIENTS

1. REVISED CARDIAC RISK INDEX (RCRI)
2. GOLDMAN CARDIAC RISK
3. DUKE ACTIVITY STATUS INDEX
4. MACE SCORE
5. ACC/AHA Risk calculator FRAMINGHAM RISK SCORE