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The Preoperative Cardiac Evaluation Assignment
The preoperative cardiac evaluation must be carefully tailored to the circumstances that have prompted the consultation and to the nature of the surgical illness as opposed to urgent or elective cases. Successful perioperative evaluation and
treatment of cardiac patients undergoing noncardiac surgery requires careful teamwork and communication between the patient, primary care physician, anesthesiologist, consultant, and surgeon. In general, indications for further cardiac
testing and treatments are the same as those in the nonoperative setting, but their timing is dependent on such factors as the urgency of surgery, the patients risk factors, and specific surgical considerations. Coronary revascularization
before surgery to enable the patient to get through the procedure is appropriate only for a small subset of patients at very high risk. Preoperative testing should be limited to circumstances in which the results will affect patient treatment and
outcomes (Sklyar & Bella, 2017).
For example, a patient will uncontrolled hypertension should be controlled before surgery. In many such instances, establishment of an effective regimen can be achieved over several days to weeks of preoperative outpatient treatment. If
surgery is more urgent, rapid-acting agents can be administered that allow effective control in a matter of minutes or hours. Beta-blockers appear to be particularly attractive agents. Continuation of preoperative antihypertensive treatment through the perioperative period is critical. Specific recommendations for supplemental preoperative evaluation must be individualized to each patient and circumstance. The following may be appropriate in more situations: assessment of resting left ventricular function, exercise stress testing, pharmacological stress testing, ambulatory ECG monitoring, and coronary angiography (Caplan & Yu, 2018).
Caplan, J., & Yu, W. (2018). Preoperative cardiac evaluation of patients uncontrolled HTN. American journal of Cardiology (Belle Mead, N.J.), 37(1), 3236.
Sklyar, E., & Bella, J. N. (2017). Cardiac Evaluation and Monitoring of Patients Undergoing Noncardiac Surgery. Health services insights, 9, 1178632916686074. https://doi.org/10.1177/1178632916686074