••• CHAPTER 34^ Preoperative Evaluation and Preparation of Gynecologic Surgery^343
❍ What is the sensitivity of stress test for coronary artery disease?
75% to 80%.
❍ After a myocardial infarction, how long should gynecologic surgery be deferred?
Usually at least 6 months to decrease reinfarction and mortality.
❍ What is the single most significant predictor of cardiac complications in the surgical patient?
The presence of congestive heart failure.
❍ When are cardiac rhythm disturbances such as premature ventricular contractions associated with increased
surgical risk?
When accompanied by decreased left ventricular function.
❍ What is the most common perioperative time period for myocardial infarction?
Postoperative day 3 to 4.
❍ What is the most common valvular abnormality of the heart?
Mitral valve prolapse.
❍ Which arrhythmias are associated with mitral valve prolapse?
Ventricular ectopic beats, atrial tachyarrhythmias, bradyarrhythmias, and rarely sudden death.
❍ How should patients with bioprosthetic valves be managed preoperatively?
Coumadin should be stopped 2 days prior to surgery so that the prothrombin time decreases to 15 seconds; the
Coumadin should be restarted as soon as it is deemed safe.
❍ What therapy do patients with Mobitz type I (Wenckebach) second-degree heart block need prior to
surgery?
No preoperative therapy needed.
❍ In patients with pacemakers, what preoperative preparation is advised?
Demand pacemakers should be converted to fixed-rate mode by passing a magnet over the pacemaker.
❍ What is the classic history of a patient with severe aortic stenosis?
Exercise dyspnea, angina, and syncope.
❍ What is the typical murmur of aortic stenosis?
Systolic murmur at the right sternal border that radiates into the carotid arteries.
❍ What is the most common cause of death in the diabetic patient?
Cardiovascular disease, which accounts for over half of deaths in diabetics.