Preoperative Cardiac Assessment

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Preoperative Cardiac Assessment

Definition

Preoperative cardiac assessment includes a series of tests given before non-cardiac surgery to determine the risk level for cardiac complications both during surgery and postoperatively. The assessment also attempts to identify any measures that can be taken to reduce these risks.

Purpose

It is estimated that about one-third of individuals in the United States who have noncardiac surgery each year have either heart disease or serious risk factors for cardiac problems. Undergoing surgery can seriously stress the body, and can lead to cardiac problems during or after surgery. The preoperative cardiac assessment attempts to determine if a patient about to undergo surgery that is not on the hear is at risk for heart-related complications. If the patient is found to be at high risk for complications steps can be taken to minimize these risks before the surgery is performed. Knowing the cardiac risk factors can also help doctors ensure that the patient gets the correct monitoring and care after the operation so that any problems can be found and treated as quickly as possible. Preoperative cardiac assessment is not usually possible before emergency surgery.

QUESTIONS TO ASK YOUR DOCTOR

If I am found to be high risk for cardiac complications, what can I do to reduce my risk?
If I am found to be high risk what does that mean for my upcoming surgery?
What further tests are necessary to most accurately determine my risk level?

Precautions

There are no specific precautions necessary for a preoperative cardiac assessment.

Description

The preoperative cardiac assessment normally consists of a physical examination, a health history , and an electrocardiogram (EKG). During the physical exam the doctor will check the patient for signs of overall health and for symptoms of cardiac-related diseases and conditions. The patient's blood pressure is also taken, and the doctor will listen to his or her heartbeat to check for problems with heart rhythm.

The health history may is an extremely important part of the preoperative cardiac assessment. The patient is asked a variety of questions about his or hear past health, past disease and conditions she or he has had, and past medical treatments and any resulting complications. This information is important because many pervious disease and conditions put an individual at increased risk for cardiac problems later on. The health history may also include questions about the current health of the patient, as well as any medications that are being taken, and any chronic disease or

conditions. The patient may also be asked about the health history of his or her immediate family, because risk for some problems, such as high blood pressure, may be party genetic and therefore run in families.

KEY TERMS

Cardiac —Of or relating to the heart.

Electrocardiogram —A recorded measurement of the electrical activity of the heart.

The preoperative cardiac assessment also includes an EKG. The EKG is sometimes done while the patient is at rest, and sometimes while the patient is participating in light exercise such as walking on a treadmill. To perform the EKG a doctor, nurse, or technician attaches 10 electrodes to the patient's skin at various locations, such as on the patient's chest and legs. The electrodes are hooked up to the EKG machine, which records the information they transmit to it and displays it on a screen. An EKG measures the electrical impulses that travel through the heart, and can provide the doctor or surgeon with a good picture of the heart's health and if a variety of specific cardiac diseases and conditions exist.

The physical exam, health history, and EKG are the three parts of a basic preoperative cardiac assessment. If the patient has risk factors for cardiac complications other, more in depth, tests might be performed to test for the existence of certain conditions or to determine the severity of existing conditions. After a patient's level of risk has been determined the doctor and surgeon can determine what types of interventions, such as putting the patient on blood-pressure lowering medications, are appropriate before the surgery.

Preparation

No special preparation is required for a preoperative cardiac assessment.

Aftercare

No aftercare is required after a preoperative cardiac assessment.

Complications

No complications are expected from a basic preoperative cardiac assessment.

Results

The results of the preoperative cardiac assessment are extremely personalized. The risk factors that can be determined often vary in severity significantly between individuals and the presence of two or more conditions often compounds the risk.

What the doctor and surgeon decide about the results of the cardiac assessment also depend heavily on the type of surgery that is going to be performed. Major surgeries, especially major surgeries performed on seniors, carry a much higher rate of serious cardiac complications than do minor surgeries. Therefore, the individual's risk assessment deemed acceptable for a minor operation may be too risky to perform without intervention to reduce risk factors for a more complex operation involving more blood loss, more anesthesia, and more time on the operating table.

Caregiver concerns

A patient's doctor or the surgeon who is performing the upcoming surgery orders a preoperative cardiac assessment. The doctor or surgeon may carry out the assessment him or herself, or a nurse or technician may carry out some parts of the test and report the results tot the doctor or surgeon. In many cases a patient's primary physician and the surgeon who is going to perform the surgery work closely together to determine risk, manage risk factors, and plan postoperative care and monitoring.