Management of cardiac risk for noncardiac surgery
- PJ Devereaux, MD, PhD
PJ Devereaux, MD, PhD
- Associate Professor of Medicine, Division of Cardiology
- McMaster University
- Steven L Cohn, MD, FACP, SFHM
Steven L Cohn, MD, FACP, SFHM
- Professor of Clinical Medicine
- University of Miami Miller School of Medicine
- Kim A Eagle, MD, MACC
Kim A Eagle, MD, MACC
- Albion Walter Hewlett Professor of Internal Medicine
- University of Michigan
- Section Editors
- Patricia A Pellikka, MD, FACC, FAHA, FASE
Patricia A Pellikka, MD, FACC, FAHA, FASE
- Section Editor — Noninvasive Cardiac Imaging and Stress Testing
- Professor of Medicine
- Mayo Clinic College of Medicine
- Allan S Jaffe, MD
Allan S Jaffe, MD
- Section Editor — Coronary Heart Disease
- Professor of Medicine
- Mayo Medical School
Cardiovascular complications, such as myocardial infarction, heart failure, or death attributable to coronary heart disease, pose one of the most significant risks to patients undergoing major noncardiac surgery. This topic will discuss potential interventions to reduce this risk in patients at relatively high baseline risk. The following issues of relevance to patients undergoing noncardiac surgery are discussed separately:
●The estimation of baseline risk (see "Evaluation of cardiac risk prior to noncardiac surgery")
●The approach to perioperative myocardial infarction (see "Perioperative myocardial infarction after noncardiac surgery")
●The perioperative evaluation and management of heart failure (see "Management of perioperative heart failure in patients undergoing noncardiac surgery")
●Noncardiac surgery in patients with valvular heart disease (see "Noncardiac surgery in patients with aortic stenosis" and "Noncardiac surgery in patients with mitral or aortic regurgitation")
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- PATIENTS WITH A RECENT ACUTE CORONARY SYNDROME
- PATIENTS WHO NEED URGENT OR EMERGENT SURGERY
- INITIAL RISK ASSESSMENT
- REVASCULARIZATION BEFORE SURGERY
- BETA BLOCKERS
- Patients without indications for long-term therapy
- Patients who may require preoperative initiation of therapy
- Patients taking beta blockers
- - Choice of agent
- - Baseline heart rate and blood pressure
- Recommendations of others
- OTHER MEDICAL THERAPIES
- Antiplatelet therapy
- Nitrate therapy
- RECOMMENDATIONS OF OTHERS
- SUMMARY AND RECOMMENDATIONS
- Angiography and revascularization
- Beta blockers
- Antiplatelet therapy