Pre Operative tests in Cardiothoracic Surgery

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

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

LFTs and calcium Alcoholics major risk factor Metastasis in lung cancer

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

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

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

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

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

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

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

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

Weight Tamponade Leg wound healing Breathless patients ? Need diuretics

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

Swabs Sternal wound and valve infection

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

Clinical Examination DONT UNDERESTIMATE THE IMPORTANCE OF THIS