ASSESSMENT OF CARDIAC RISK IN NONCARDIAC SURGERY

Surgical techniques have been refined so that complications directly r esulting from surgical procedures are relatively small. However, with the high prevalence of coronary artery disease in the United States, m any surgical patients have concomitant coronary artery disease. Anesth esia as well as the surgical procedure induce stresses on the heart an d circulatory system which could result in perioperative cardiac morbi dity and mortality. Assessing patients prior to surgical procedures by history, physical examination, laboratory data, and newer cardiovascu lar diagnostic procedures can stratify the cardiac risk and help to pr edict the incidence of perioperative cardiac morbidity and mortality. If great risk exists, an alternative therapy or cancellation of the su rgical procedure may be considered. In certain subgroups of patients, coronary artery revascularization, valvular heart surgery, or beginnin g medical therapy of the underlying cardiac pathology could be perform ed prior to the surgical procedure. If this cannot be arranged for the high-risk patients, more intensive and invasive hemodynamic monitorin g and optimal medical management perioperatively might reduce cardiac complications.