Longnecker's Anesthesiology > Part 2. Preparing for Anesthesia > Section B. Preoperative Evaluation of the Anesthesia Patient > Chapter 7. Evaluation of the Patient with Cardiovascular Disease Ronald P. Olson, MD

Key Points

"1. Although imbalance of oxygen supply and demand of the myocardium during perioperative stress continues to be a common mechanism of perioperative morbidity and mortality, an equally important cause is the rupture of a vulnerable plaque with subsequent thrombosis of a coronary artery. Maintenance of healthy endothelial function is vital to prevent this.

2. Perioperative risk assessment requires consideration of the functional status of the patient and the risk inherent in the surgical procedure, as well as the diseases of the patient and how optimal is the disease management.

3. The history and physical examination, along with limited indicated tests, are often adequate to determine the perioperative risk of a patient. Preoperative cardiac testing is generally not needed unless a patient has at least two of the following: chronic disease, need for high risk surgery, poor exercise tolerance. Perhaps surprisingly, preoperative cardiac testing is sometimes not needed in patients who have two or three of these conditions, but who have detailed documentation of optimal management. Further testing is unlikely to change management and these patients may proceed directly to surgery.

4. Preoperative cardiac testing is most useful in those patients who do not clearly fit into the low-risk or the fully optimized category. In these patients, further testing is usually needed to formulate an anesthesia plan.

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