Detailed cardiovascular assessment.
Where indicated, not only should the global ventricular function be assessed by
echocardiography, but angiography with angioplasty may improve coronary flow
prior to elective surgery. Elective surgery should be postponed until at
least 6 months from any myocardial infarction. Current congestive heart
failure also carries higher risk of another perioperative cardiac event.
Obtain drug history (nitrates, beta blockers, calcium channel blockers,
antiplatelet agents, digoxin). Patients with painful arthritis may be on
long-term nonsteroidal anti-inflammatory drugs (NSAIDs). The signs and symptoms of anemia must be sought. Anemia is
poorly tolerated in patients with coronary artery disease and every effort
should be made to correct the deficit preoperatively. Investigations: cell blood count, ECG, chest
radiograph, coagulation studies, and bleeding time if the patient is on
antiplatelet agents and/or heparin. Premedication with adequate sedation to
reduce anxiety, continue medical therapy, and administer oxygen therapy
during transport to the operating theatre.