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(Circulation. 2003;107:2771.)
© 2003 American Heart Association, Inc.

Clinician Update

Perioperative Cardiac Assessment for Noncardiac Surgery

Eight Steps to the Best Possible Outcome

Debabrata Mukherjee, MD; Kim A. Eagle, MD

From the University of Michigan, Ann Arbor.

Correspondence to Kim A. Eagle, MD, Division of Cardiology, University of Michigan Health System, 3910 Taubman Center, 1500 E Medical Center Dr, Ann Arbor, MI 48103. E-mail keagle@umich.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The prevalence of cardiovascular disease in the United States¹ and the number of noncardiac surgical procedures performed are progressively increasing. Preoperative risk assessment is an important step in reducing perioperative morbidity and mortality in patients undergoing noncardiac surgery. Successful perioperative evaluation is best achieved by combining an integrated multidisciplinary approach with good communication between the patient, primary care physician, anesthesiologist, consultant, and surgeon. The goal of appropriate preoperative evaluation and therapy should be to not only improve immediate periprocedural outcomes but also to improve long term clinical outcome.

	Eight Steps to the Optimal Perioperative Outcome

 
Case
A 68-year-old man with diabetes, hyperlipidemia, and lifestyle-limiting claudication requires aorto-bifemoral bypass surgery. He has a history of prior myocardial infarction 6 years ago and has had infrequent episodes of angina since then. His ability to perform physical activity is limited by claudication. He is currently taking aspirin, long-acting nitrates, glyburide, and lovastatin. Does he need further evaluation before his elective surgery? What can be done to minimize his risk of perioperative complications?

(1) Assess the Patient’s Clinical Features
The history and physical examination should emphasize identification of markers of cardiac risk and assess the patient’s cardiac status. High-risk cardiac conditions include recent myocardial infarction (MI), decompensated heart failure (HF), unstable angina, symptomatic arrhythmias, and symptomatic valvular heart disease. The patient’s underlying cardiac conditions, although apparently stable at present, may become manifest during perioperative stresses. Such conditions include stable angina, distant MI, prior HF, or moderate valvular disease. One should also identify serious comorbid conditions such as diabetes, stroke, renal insufficiency, and pulmonary disease because these illnesses may . . . [Full Text of this Article]

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