Integrating the revised cardiac Risk index(RCRI) and Ney York heart Association (NYHA) Classification.

Integrating the revised cardiac Risk index(RCRI) and Ney York heart Association (NYHA) Classification.

1. Integrating the revised cardiac Risk index(RCRI) and Ney York heart Association (NYHA) Classification. by Monnaf Ali Msc OTAT

2. Introduction Pre-operative assessment : Is a critical steps before any surgical procedure.it involves a comprehensive evaluation of a patients health status to ensure they are fit for surgery and to identify any potential risks. Purpose of pre-operative assessment: -To evaluate the patients overall health. -To identify potential risks associated with surgery. -To ensure the patient is medically optimized before surgery.

3. Components of pre-operative Assessment Medical history: -Past medical and surgical history. -Medications and allergies. -Family history of anaesthesia complication . Physical examination: -general and systemic examination. -Airway assessment. Laboratory Tests: -blood tests ,urinalysis and blood grouping. Imaging studies: - chest x-ray , ECG , and others as needed.

4. Risk stratification in pre-operative Assessment. Purpose: -Identify patients at increased risk for perioperative complication. Tools used: -Revised Cardiac Risk index(RCRI). -New York Heart Association(NYHA) Functional Classification.

5. Introduction to Revised Cardiac Risk Index(RCRI) What is RCRI? -It is a pre-operative tool to estimate the risk of major cardiac events in non-cardiac surgery. -Based on six key Variables. Why it matters. -Helps guide decisions about further cardiac evaluation and perioperative care.

6. Components of the RCRI Six independent Predictors 1.History of Ischemic Hearth Disease. 2.History of congestive hearth failure. 3.History of cerebrovascular disease(stroke or transient ischemic attack). 4.History of Diabetes Requiring Insulin. 5.Chronic kidney Disease serum creatinine greater then 2 mg/dl. 6.Undergoing High risk surgery suprainguinal vascular , intraperitoneal or intrathoracic surgery.

7. Scoring of RCRI 0 points-Low risk(0.4 % chance of major cardiac complication. 1 points-Intermediate risk(1.0% chance of major cardiac complication. 2 points-Moderate risk(2.4% changes of major cardiac complication. ≥3 points-High risk( greater than 5.4% chances of major cardiac complications).

8. Introduction to new York hearth Association(NYHA) Functional classification What is the NYHA classification? A system to classy the severity of hearth failure based on symptoms and physical activity. Why it matters Help in assessing the functional impact of hearth failure on the patient’s daily life and surgical risk.

9. NYHA Functional classes Class I: No limitation of physical activity ;ordinary activity does not cause symptoms. Class II: Slight limitation ;ordinary activity results in symptoms. Class III: Marked limitation ; less than ordinary activity causes symptoms. Class IV: Severe limitation ; symptoms occurs even at rest.

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