TY - CHAP M1 - Book, Section TI - ACC/AHA Guidelines on Perioperative Cardiac Evaluation A1 - Bailin, Michael A1 - Spanakis, Spiro PY - 2000 T2 - Guidelines AB - |PrintACC/AHA Guidelines on Perioperative Cardiac EvaluationComments by Kathleen ChaimbergPopulationDefinitionRecommendationCommentsPatients for EMERGENCY surgery.There is an indication for operative intervention which is considered urgent such that any delay in proceeding may result in significant morbidity or mortality.Proceed to the OR.No further testing indicated.The anesthesiologist may have significant impact on patient care with respect to intraoperative monitoring, perioperative management and appropriate postoperative surveillance.Patients with ACTIVE CARDIAC conditions.Unstable coronary syndromes (e.g., severe angina, recent MI)Decompensated heart failureSignificant arrhythmiasSevere valvular diseaseElective surgery should be delayed until the patient is evaluated to assess the current condition and define therapeutic options.After this evaluation, it may be appropriate to proceed with the noncardiac surgery without a specific intervention but with maximal medical therapy.Patients for LOW RISK surgery.The reported risk of cardiac death or non-fatal MI is 2.Proceed to the OR.No further testing indicated.In patients without cardiac risk factors, non-invasive testing will not change their management even if their functional capacity is poor.Patients with UNKNOWN or POOR functional capacityAND1 to 2 CLINICAL RISK FACTORS scheduled for INTERMEDIATE or VASCULAR surgery.1 to 2 of the above listed clinical risk factors.It is REASONABLE* to proceed to the OR without further testing. Noninvasive testing MAY BE† considered IF it will change patient management.If the patient does proceed to the OR without testing, it may be appropriate to consider heart rate control with beta blockade.Patients with UNKNOWN or POOR functional capacityAND3 or more CLINICAL RISK FACTORS scheduled for INTERMEDIATE surgery.3 or more of the above listed clinical risk factors. Reported risk of cardiac death or non-fatal MI between 1 to 5%.Same as above.Same as above.Patients with UNKNOWN or POOR functional capacityAND3 or more CLINICAL RISK FACTORS scheduled for VASCULAR surgery.3 or more of the above listed clinical risk factors.Aortic or other major vascular surgery; reported risk potentially >5%.Consider stress testing IF it will change patient management.Data from the CARP1 and DECREASE II2 trials call into question the efficacy of preoperative revascularization as a means of reducing the risk of a cardiac event following subsequent non-cardiac surgery.Source: Fleisher LA et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Non-Cardiac Surgery. J Am Coll Cardiol (2007), 50: 1707-32 [go to full text of guideline] SN - PB - The McGraw-Hill Companies, Inc. CY - New York, NY Y2 - 2024/03/28 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=5010048 ER -