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(Circulation. 2007;116:e418-e500.)
© 2007 American Heart Association, Inc.

ACC/AHA Guideline

ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery

A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)

Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery

WRITING COMMITTEE: Lee A. Fleisher, MD, FACC, FAHA, Chair; Joshua A. Beckman, MD, FACC^¶; Kenneth A. Brown, MD, FACC, FAHA; Hugh Calkins, MD, FACC, FAHA; Elliot L. Chaikof, MD^#; Kirsten E. Fleischmann, MD, MPH, FACC; William K. Freeman, MD, FACC^*; James B. Froehlich, MD, MPH, FACC; Edward K. Kasper, MD, FACC; Judy R. Kersten, MD, FACC; Barbara Riegel, DNSc, RN, FAHA; John F. Robb, MD, FACC^||

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

	Introduction

 

Preamble...e420

   1. Definition of the Problem...e421

      1.1. Purpose of These Guidelines...e421

      1.2. Methodology and Evidence...e421

      1.3. Epidemiology...e421

      1.4. Practice Patterns...e421

      1.5. Financial Implications...e423

   2. General Approach to the Patient...e423

      2.1. Role of the Consultant...e423

      2.2. History...e424

      2.3. Physical Examination...e424

      2.4. Comorbid Diseases...e425

         2.4.1. Pulmonary Disease...e425

         2.4.2. Diabetes Mellitus...e425

         2.4.3. Renal Impairment...e425

         2.4.4. Hematologic Disorders...e426

      2.5. Ancillary Studies...e426

      2.6. Multivariable Indices to Predict Preoperative Cardiac Morbidity...e426

      2.7. Clinical Assessment...e427

         2.7.1. Stepwise Approach to Perioperative Cardiac Assessment...e427

   3. Disease-Specific Approaches...e430

      3.1. Coronary Artery Disease...e430

         3.1.1. Patients With Known CAD ...e430

         3.1.2. Influence of Age and Gender...e430

      3.2. Hypertension...e430

      3.3. Heart Failure...e431

      3.4. Cardiomyopathy...e432

      3.5. Valvular Heart Disease...e432

      3.6. Arrhythmias and Conduction Defects...e433

      3.7. Implanted Pacemakers and ICDs ...e433

      3.8. Pulmonary Vascular Disease and Congenital Heart Disease...e433

   4. Surgery-Specific Issues...e434

      4.1. Urgency...e434

      4.2. Surgical Risk...e434

   5. Supplemental Preoperative Evaluation...e437

      5.1. Assessment of LV Function...e437

      5.2. Assessment of Risk for CAD and Assessment of Functional Capacity...e438

         5.2.1. The 12-Lead ECG...e438

         5.2.2. Exercise Stress Testing for Myocardial Ischemia and Functional Capacity...e438

         5.2.3. Noninvasive Stress Testing...e440

            5.2.3.1. Radionuclide Myocardial Perfusion Imaging Methods...e440

            5.2.3.2. Dobutamine Stress Echocardiography...e443

            5.2.3.3. Stress Testing in the Presence of Left Bundle-Branch Block...e445

         5.2.4. Ambulatory ECG Monitoring...e445

      5.3. Recommendations: If a Test Is Indicated, Which Test?...e446

   6. Implications of Guidelines and Other Risk Assessment Strategies for Costs and Outcomes...e446

   7. Perioperative Therapy...e447

      7.1. Preoperative Coronary Revascularization With CABG or Percutaneous Coronary Intervention...e447

         7.1.1. Rationale for Surgical Coronary Revascularization...e448

         7.1.2. Preoperative CABG ...e448

         7.1.3. Preoperative PCI ...e450

         7.1.4. PCI Without Stents: Coronary Balloon Angioplasty...e452

. . . [Full Text of this Article]

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