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Preoperative Cardiac Evaluation for Elective Noncardiac Surgery

Preoperative Cardiac Evaluation for Elective Noncardiac Surgery,Darryl Potyk,Peter Raudaskoski

Preoperative Cardiac Evaluation for Elective Noncardiac Surgery   (Citations: 12)
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e reviewed the approach to preoperative cardiac risk assessment, incorporating new information regarding the pathophysiologic features of perioperative myo- cardial ischemia and recent clinical trials. Relevant articles were identified from a MEDLINE search, followed by bibliography review of the articles identified. The multifactorial risk indexes are valuable in stratifying risks among unselected patients under- going noncardiac surgery, but they underestimate the risks in selected groups, particularly pa- tients with peripheral vascular disease. The preoperative evaluation of patients with coronary ar- tery disease and risk reduction strategies for high-risk patients are considered. There are no prospective randomized clinical data comparing preoperative revascularization to intensive medical therapy and clinical decisions must be individualized. Risks particular to patients with congestive heart failure and valvular heart disease are also reviewed. Patients with congestive heart failure can un- dergo noncardiac surgery safely, if their cardiac disease is well-compensated. Patients with aortic stenosis have high risks, and management strategies include valve replacement, aortic valvulo- plasty, and aggressive medical treatment. These modalities have not been compared prospectively, and clinical decisions must be individualized. Preoperative arrhythmias are important risk factors, although they appear to confer risk only when due to underlying heart disease. A thorough, tar- geted history and physical examination supplemented with judicious laboratory studies are usu- ally sufficient to assess a patient's risk for upcoming noncardiac surgery. The clinical history should identify risk factors that predict cardiac complications, and special attention should be given to those risk factors that can be modified before surgery. New developments in perioperative medi- cine will likely lead to postoperative interventions to reduce silent myocardial ischemia and clini- cal complications. Arch Fam Med. 1998;7:164-173 Each year, approximately 25 million people in the United States undergo non- cardiac surgery. Approximately 8 million of these have cardiac disease or major cardiac risk factors or are older than 65 years. Therefore, it is not surprising that cardiac complications occur when these patients are subjected to stress during the 3- to 4-day perioperative period. Current estimates of serious periopera- tive cardiac morbidity vary between 1% and 10%, depending on the subset of patients and the type of surgical proce- dure. About 4% of patients suffer serious perioperative cardiac morbidity follow-
Published in 1998.
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