Overview of Preoperative Cardiac Risk Assessment for the General Internist

Terry Shaneyfelt, MD, MPHAssociate Professor, UAB Department of Medicine

• Adult patients, 50 yrs of age or older, undergoing noncardiac surgery

• Unstable or new cardiac symptoms should be evaluated according to current guidelines

Disclaimer

Cardiac Risk Assessment

• Goals: 1. Assess cardiac risk of planned surgical procedure2. Determine the need for changes in management3. Identification of cardiovascular conditions or risk

factors requiring longer-term management

• 3 components:• History• Physical exam• Cardiac Testing

Take a good cardiac HISTORY

Detection of serious

cardiac conditions

Evaluation of the stability of known CAD

Assessment of comorbidities

know to influence

perioperative cardiac outcomes

Appraisal of functional capacity Cardiac meds

Higher functional capacity = fewer perioperative complications

Functional Capacity

From Eur Heart J.

Perform a careful cardiovascular EXAM

Status/control of cardiovascular

disease

Detection of significant valvular

disease

Peripheral vascular disease

• Revised cardiac risk index

• Gupta risk calculator (NSQIP)

Predict Perioperative Cardiovascular Risk

Do I need to get a Preoperative ECG?

Ann Surg 2007;246:165