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Periop Cardiac Eval

Perioperative Cardiac Evaluation

Guidelines

Guidelines for Perioperative Cardiovascular Evaluation for Noncardiac Surgery
American College of Cardiology / American Heart Association
JACC 1996; 27:910-948; and Circulation 1996; 93:1278-1317.
Pocket Guideline: requires Adobe Acrobat Reader
Need for cardiac surgery?
Coronary revascularization within 5 years?
Recurrent symptoms or signs?
Recent coronary evaluation?
Recent coronary angiogram or stress test?

Clinical Predictors:

Major Clinical Predictors:
lRecent MI (< 1 month ago) with evidence of important ischemic risk by clinical symptoms or noninvasive study
lUnstable or severe angina (Canadian Cardiovascular Society Class III or IV)

 
l High-grade atrioventricular block
l Symptomatic ventricular arrhythmias in the presence of underlying heart disease
l Supraventricular arrhythmias with uncontrolled ventricular rate

 

Intermediate Clinical Predictors:

Minor Clinical Predictors:
  • Consider delay or cancel noncardiac surgery
  • Medical management and risk factor modification
  • Consider coronary angiography
Subsequent care dictated by findings and treatment results
Subsequent care may include cancellation or delay of surgery, coronary revascularization followed by noncardiac surgery, or intensified care.
Intermediate Clinical Predictors
Functional Capacity:

Surgical Risk:
Results of Non-Invasive Testing:
Myocardial perfusion imaging or stress echocardiography
Subsequent care may include cancellation or delay of surgery, coronary revascularization followed by noncardiac surgery, or intensified care.
Minor Clinical Predictors
Functional Capacity:
Minor Clinical Predictors
Surgical Risk:

DISCLAIMER

DISCLAIMER: All calculations must be confirmed before use. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgement. Neither ValueMD nor any other party involved in the preparation or publication of this site shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.


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