-Should pt have surgery? Emergent or not?
-Type of surgery and type of anesthesia?
-Functional status of the pt?
-Relevant medical hx and any ongoing cardiac sx?
-Review the meds.
-Prior cardiac w/u.
Focus on good history and PE, can save a lot of tests & 💸
Very thorough and informative 📃.
Assess pt`s clinical risk
💠ACC 2009- Low, medium or high risk.
💠ACC 2014 update- Low risk ( <1% risk of MACE) or elevated risk (>1% MACE)
⚠️Recent (<30 days) or active MI, unstable or severe.
⚠️Acute decompensated HF
⚠️Severe symptomatic valvular disease
⚠️Significant arrhythmias (tachy/brady)
Consider delaying non-emergent surgery if present.
Symptomatic- Rx before elective surgery
💠Symptomatic AS -⬆️ periop mortality ~10%; Rx prior to surgery
💠Severe, asymptomatic AS-acceptable risk(avoid low preload)
💠Severe MV stenosis- avoid ⬆️HR
💠AR/MR-usually well tolerated
☑️Risk stratify, not “clear”
☑️Use “team” approach
☑️Use risk prediction 🛠️
☑️ Obtain good history and PE
☑️Use additional testing cautiously; can delay the surgery
☑️Manage meds, anti-platelets and pts with recent PCI carefully
☑️Remember the “DONTs”