Pre Operative tests in Cardiothoracic Surgery

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Pre Operative tests in Cardiothoracic Surgery
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FBC

• HB
• Anaemia ? Why
• Anticoagulation type of valve
• WCC
• neutrophilia
• neutropaenia
• Prosthetic valve endocarditis has 50 mortality
• PLT
• Thrombocytosis
• Thrombocytopaenia
• Aspirin and clopidogrel have no effect

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U E

• Na
• Paraneoplastic in Ca lung
• Confusion in old grannies
• K
• Arrthymias
• Urea
• GI bleed
• Diuretic use
• Dehydration
• Creatinine
• Major risk factor for dying post cardiac surgery

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LFTs and calcium

• Alcoholics major risk factor
• Metastasis in lung cancer

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Clotting

• Pro coagulant
• Lupus anticoagulant
• Block the grafts
• Bleed
• Monitor heparin and warfarin therapy and reversal
• VonWillibrands
• Haemophilia A
• Christmas disease (Haemophilia B)

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Glucose

• Diabetes is major risk factor for dying
• Poorly controlled means metabolic problems post
  operatively
• Newly diagnosed in CABG patients

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ECG

• Normal or not
• Rate eg brady
• PR interval
• LV hypertrophy
• Bundle branch block
• ST levels in CABG
• Pacemaker

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PFTs

• Epidural use
• Nebulsiers use
• Risk of thoracotomy
• Valve patients different to CABG patients
• Thoracic surgery
• Rule of 19 for predicting post operative FEV1

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CXR

• Size heart
• Risk
• Cardioplegia
• Trauma
• Aortic calcification CVA risk eg Cannulation ?
  Off pump
• Lung cancer as most are ex or current smokers
• ribs ? sternum in past
• Wires from previous sternotomy

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Angiogram

• ?needs CABG
• LMS length
• Circ size in mitral surgery
• Aortic calcification
• Amount aortic regurgitation
• LV function
• Aortic valve calcification ? CVA risk

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CT

• Redo surgery ? RV and sternum separation
• Aortic sizes ? Need root or arch
• Thoracic surgery
• Tumour
• Mediastinal LNs
• Metastatic spread

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Echo

• All murmurs need evaluating
• Always check supposedly normal valves
• Pulmonary and tricuspid valves rarely commented
  on with mitral valve patients
• PA pressure MAJOR risk factor
• LV and RV function

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Weight

• Tamponade
• Leg wound healing
• Breathless patients ? Need diuretics

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BP

• Left and right arm for LIMA
• Level that kidneys and brain expect

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Swabs

• Sternal wound and valve infection

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Carotid scans

• Type of operation
• Blood pressure on bypass
• Risk of stroke
• ? Combined procedure

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Clinical ExaminationDONT UNDERESTIMATE THE
IMPORTANCE OF THIS