RT Book, Section
A1 Alyesh, Daniel
A1 Eagle, Kim
A2 Fuster, Valentin
A2 Harrington, Robert A.
A2 Narula, Jagat
A2 Eapen, Zubin J.
SR Print(0)
ID 1191187988
T1 PERIOPERATIVE EVALUATION FOR NONCARDIAC SURGERY
T2 Hurst's The Heart, 14e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071843249
LK accessmedicine.mhmedical.com/content.aspx?aid=1191187988
RD 2024/04/25
AB SummaryThis  chapter  discusses  the  perioperative  evaluation  and  management  of  cardiac  disease  in  patients  undergoing  noncardiac  surgery.  In  perioperative  management,  a  careful  history  and  physical  examination  directed  at  finding  and  grading  cardiac  disease  is  imperative.  Evaluation  of  cardiac  disease  prior  to  surgery  should  involve  consideration  of  whether  the  cardiac  disease  is  active  or  stable,  and  of  the  urgency  and  risk  of  the  procedure  required.  Active  cardiac  disease  typically  requires  delay  of  surgery  that  is  not  time-sensitive  (see  accompanying  Hurst’s  Central  Illustration).  In  patients  with  stable  cardiac  disease,  risk-stratification  methodologies,  approaches  to  perioperative  testing,  and  medical  management  are  important  components  of  perioperative  evaluation.  Perioperative  risk  stratification  involves  evaluation  of  the  inherent  risk  of  the  noncardiac  operation  and  of  the  risk  attributed  to  patient-specific  conditions.  In  the  setting  of  stable  cardiac  disease,  assessment  of  the  patient’s  symptoms,  exercise  status,  and  functional  capacity  should  be  used  to  determine  whether  further  cardiac  testing  is  required;  further  perioperative  testing  should  be  limited  to  circumstances  that  would  change  management  independent  of  the  surgery  planned.  After  a  thorough  history,  physical  examination,  and  risk  stratification,  titration  or  addition  of  cardiac  medications  can  be  helpful  in  perioperative  management  of  select  patients  with  stable  cardiac  disease,  though  care  should  be  taken  to  not  begin  or  withdraw  therapies  abruptly  in  the  perioperative  period.