Preoperative Cardiovascular Risk Assessment for Non-cardiac Surgery

Abstract

The purpose of preoperative evaluation is to optimize the patient’s status before surgery and thereby minimize risk. Generally the most feared post-operative cardiac complications are myocardial infarction, heart failure, malignant arrhythmias, and death. Factors to consider during the preoperative evaluation are patient risk factors, patient functional capacity, and the type of surgery the patient will undergo. Patients with comorbidities such as peripheral arterial disease have higher incidences of underlying coronary artery disease and left ventricular dysfunction. Deconditioned patients also have a higher incidence of cardiac complications. Finally, certain procedures, such as vascular surgery or major thoracic and abdominal procedures, predispose to myocardial ischemia due to greater blood loss, fluid shifts, increased myocardial oxygen demand (due to increased heart rate and blood pressure), and increased post-operative platelet reactivity.