Cardiac Disease



Preoperative cardiac risk assessment has evolved over the past 40 years from a simple global assessment of a patient’s physical status (the ASA classification1) to multivariate risk analyses (Goldman2, Detsky3) to a simplified scoring system (Lee RCRI4) to guidelines (ACC/AHA, ACP). The latest of these is the ACC/AHA guidelines for perioperative cardiac evaluation and management, originally published in 1996 and updated in 20075 to incorporate the RCRI factors. Using these guidelines, which emphasize clinical evaluation and selective cardiac testing (pharmacologic stress tests only in situations where it is likely to change management), physicians are now better able to provide a more accurate assessment of perioperative risk, and the focus has turned to risk reduction strategies. These include revascularization (CABG or PCI), medical therapy (beta-blockers, alpha-agonists, statins), and other intraoperative measures (normothermia, anesthetic technique).


Percutaneous Coronary Intervention Coronary Artery Bypass Grafting Aortic Stenosis Pretest Probability Dobutamine Stress Echocardiography 


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Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  1. 1.Internal Medicine-Medical Consultation ServiceSUNY Downstate - Kings County Hospital CenterBrooklynUSA

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