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Table 7-1 Lee’s Revised Cardiac Risk Index 
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Based on the American College of Cardiology/American Heart Association guidelines on perioperative evaluation for noncardiac surgery, cardiac risk factors can be segregated into two categories: active cardiac conditions (formerly known as major risk factors) and clinical risk factors (formerly known as intermediate risk factors) (Tables 7-2 and 7-3). Noncardiac surgical procedures are also stratified based on cardiac risk (Table 7-4).

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Table 7-2 Active Cardiac Conditions 
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Table 7-3 Clinical Risk Factors 
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Table 7-4 Cardiac Risk Stratification for Noncardiac Surgical Procedures 
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The stepwise approach to perioperative cardiac assessment is based on the presence of cardiac risk factors, risk stratification of the surgical procedure, and patient’s functional capacity (Figure 7-1). Diagnostic evaluation and treatment is indicated for patients with active cardiac conditions (Table 7-2) such as unstable angina or decompensated heart failure. Additional diagnostic testing such as a stress test should also be considered in patients undergoing vascular procedures (Table 7-4) who suffer from three or more clinical risk factors (Table 7-3) and have poor functional capacity.

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Figure 7-1. Stepwise Approach to Perioperative Cardiac Assessment
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