Overview of preoperative cardiac risk assessment
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Overview of Preoperative Cardiac Risk Assessment for the General Internist
Terry Shaneyfelt, MD, MPHAssociate Professor, UAB Department of Medicine
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• Adult patients, 50 yrs of age or older, undergoing noncardiac surgery
• Unstable or new cardiac symptoms should be evaluated according to current guidelines
Disclaimer
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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
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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
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Higher functional capacity = fewer perioperative complications
Functional Capacity
From Eur Heart J.
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Perform a careful cardiovascular EXAM
Status/control of cardiovascular
disease
Detection of significant valvular
disease
Peripheral vascular disease
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• Revised cardiac risk index
• Gupta risk calculator (NSQIP)
Predict Perioperative Cardiovascular Risk
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Do I need to get a Preoperative ECG?
Ann Surg 2007;246:165
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