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Cardiac Evaluation

The purpose of a preoperative evaluation is not only to “clear” patients for elective surgery, but rather to evaluate and, if necessary, implement measures to prepare higher risk patients for surgery. Pre- operative outpatient medical evaluation can decrease the length of hospital stay as well as minimize postponed or cancelled surgeries.
To effectively provide this consultative service, we at Sattur Heart Care understand the risk associated with the particular type of surgery planned and relate this risk to the patient's underlying acute and chronic medical problems. The complete consultation includes detailed history , examination , investigations for evaluation and treatment, including prophylactic therapies to minimize the perioperative risk.

The below table shows some of the recommended tests which are followed:

Healthy patient ≤ 40 years Hemoglobin, urine screening for pregnancy in women of childbearing potential
Healthy patient > 40 years Add ECG and blood glucose (age ≥ 45 years)
Cardiovascular disease ECG, chest radiographs, hemoglobin, electrolytes, BUN, creatinine, glucose (age ≥ 45 years or history of diabetes)
Recent MI (≤6 weeks), unstable angina, decompensated CHF, significant arrhythmias, severe valvular disease Cardiology consultation
Previous MI (> 6 weeks ago), mild stable angina, compensated CHF, diabetes mellitus Stress test if high-risk procedure or patient has low functional capacity; consider assessment of left ventricular function (i.e., echocardiography)
Rhythm other than normal sinus rhythm, abnormal ECG, history of stroke, advanced age, low functional capacity Stress test if high-risk procedure and patient has low functional capacity
Pulmonary disease Chest radiographs, hemoglobin, glucose (age ≥ 45 years), ECG (age > 40 years); provide patient with instructions for incentive spirometry or deep- breathing exercises
Asthma Pulmonary function testing or peak flow rate to assess disease status
COPD Consider pulmonary function testing and arterial blood gas analysis for assessment of disease severity
CoughEvaluate for etiology Evaluate for etiology
Dyspnea Evaluate for etiology
Smoking Counsel patient to stop smoking 4 to 8 weeks before surgery
Obesity Provide patient with instructions for incentive spirometry or deep-breathing exercisesAbdominal or thoracic surgery
Abdominal or thoracic surgery Provide patient with instructions for incentive spirometry or deep-breathing exercises
Malnutrition Laboratory tests based on primary disease, plus albumin and lymphocyte count; if malnutrition is severe, consider postponing surgery and providing preoperative supplementation