Key components for preoperative cardiac risk assessment

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Key components for preoperative cardiac risk assessment

Patient related

History

Prior cardiac disease Previous MI: recent (<2 months); remote

Angina (stable?/NYHA Class)
HF (systolic/diastolic/symptoms/EF)
Arrhythmias/pacemaker/ICD
Valvular disease (AS/MS, severity, symptoms)

Prior cardiac intervention CABG

PCI (BA, BMS, DES)
What? When? Recurrent symptoms?

Prior cardiac evaluation (diagnostic tests) ECG

Stress test (exercise, with or without imaging;
pharmacologic, with echo or nuclear imaging)
Echo
Angiography or CCTA

Risk factors for CAD Age

Male sex
HTN
DM
Dyslipidemia
Smoking

Comorbidities associated with CAD CVA

PAD
CKD
COPD
OSA

Current symptoms Chest pain

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Key components for preoperative cardiac risk assessment
Dyspnea
Functional status (independent?)
Exercise capacity (>4 METs, 2 flights of stairs?)
DASI score

Cardiovascular medications Antiplatelet

Beta blocker
ACEI/ARB
Nitrates
Other antianginal or antihypertensive
Statin
Anticoagulant

Physical examination

BP
Heart rate and regularity
RR (tachypnea)
JVD
Murmur
S3
Rales
Edema

Biomarkers

BNP
Troponin

Surgery related

High risk:
Major vascular (AAA, suprainguinal bypass)
Major procedures with significant blood loss or fluid shifts
Intermediate risk:
Intraperitoneal
Intrathoracic (non-major)
CEA, endovascular surgery
Major orthopedic

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Key components for preoperative cardiac risk assessment
Emergency surgery

MI: myocardial infarction; NYHA: New York Heart Association; HF: heart failure; EF: ejection fraction;
ICD: implantable cardioverter-defibrillator; AS: aortic stenosis; MS: mitral stenosis; CABG: coronary
artery bypass graft; PCI: percutaneous coronary intervention; BA: balloon angioplasty; BMS: bare
metal stent; DES: drug-eluting stent; ECG: electrocardiogram; CCTA: coronary computed tomography
angiography; HTN: hypertension; DM: diabetes mellitus; CVA: cerebrovascular accident; PAD:
peripheral artery disease; CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease;
OSA: obstructive sleep apnea; METS: metabolic equivalents; DASI: Duke Activity Status Index; ACEI:
angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; BP: blood pressure; RR:
respiratory rate; JVD: jugular venous distention; BNP: brain natriuretic peptide; AAA: abdominal aortic
aneurysm; CEA: carotid endarterectomy.

Reproduced with permission from: Cohn SL. Ischemic heart disease. In: Decision Making in Perioperative Medicine:
Clinical Pearls, Cohn SL (Ed), McGraw Hill 2021. Copyright © 2021 McGraw Hill. McGraw Hill makes no representations
or warranties as to the accuracy of any information contained in this McGraw Hill material, including any warranties of
merchantability or fitness for a particular purpose. In no event shall McGraw Hill have any liability to any party for
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