A 68-year-old man is scheduled for open repair of an infrarenal abdominal aortic aneurysm. He has insulin-treated diabetes mellitus and a serum creatinine of 2.4 mg/dL. He has no history of ischaemic heart disease, cerebrovascular disease or heart failure. According to the Revised Cardiac Risk Index, how many risk factors does he have?

• A Three risk factors ✓
• B Two risk factors
• C One risk factor
• D Four risk factors

Explanation

The Revised Cardiac Risk Index counts six variables: high-risk surgery (intraperitoneal, intrathoracic, suprainguinal vascular), ischaemic heart disease, congestive heart failure, cerebrovascular disease, insulin-treated diabetes, and creatinine above 2 mg/dL. This patient has high-risk vascular surgery, insulin-treated diabetes and renal impairment, giving three factors, which places him in the highest risk category with a predicted major cardiac complication rate above 11%. Heart failure and stroke are absent, so four factors is incorrect.

Reference: Miller's Anesthesia, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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