Pre-op Cardiac evaluation:

• See other card for clinical predictors

• See other card for stratification for noncardiac surgical procedure
• See the algorithm
• Recent MI wait 4-6 wks for elective surgery
• Lab evaluation
o Resting LV function is not a predictor for ischemic event
o 12 leads ECG
o Exercise or pharma stress test for Pt with intermediate risk, or when Pt
is unreliable
o Angio for Pt suspected or known CAD
• Pre-op therapy
o CABG for high risk Pt, with possibility to improve outcome
o PCA: no controlled trial for PCA vs medical therapy, If Pt had PCA,
with balloon dilation only, wait only for one week for elective
procedure, if stent 4-6 wks with minimum 2 wks, for anti-PLT therapy
o Medical: β -blokers
• Anesthetic consideration
 o No technique is superior
o Good post-op pain control → ↓ catecholamine surge, hyper-coag
o TEE when indicated
o Maintain normothermia → ↓ cardiac event in one study
o 12-ECG pre-op as baseline, one immediately post-op, and 48 hrs later
o Cardiac enzyme if : Pt is symptomatic, ECG changes, or hemodynamic
instability
o For high risk Pt consider ICU
• Hemodynamic goals
o Is to maintain supply/demand by
o Supply: O2 sat, Hb, and maintain DBP
o Demand : ↓HR, pressure work(afterload)