This presentation is for medical risk evaluation of patients prior to undergoing surgery or any medical procedures...

1. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary L.A. Fleisher, et al. , Circulation. Sept 27, 2007. Paulene C. Azucena, MD

6. Active Cardiac Conditions for which the Patient should Undergo Evaluation and Treatment before Noncardiac Surgery Examples Condition Severe aortic stenosis Symptomatic mitral stenosis Severe valvular disease High-grade AV Block Mobitz II AV Block 3 ° AV Block Symptomatic Ventricular Arrhythmias Supraventricular arrhythmias Symptomatic bradycardia Newly recognized ventricular tachycardia Significant arrhythmias Decompensated HF (NYHA FC IV; worsening or new-onset HF) Unstable or Severe Angina Recent MI (> 7days but ≤ 30days) Unstable Coronary Syndromes

8. Cardiac Risk Stratification: patient-specific factors and procedure-specific risk

14. Recommendations

21. Limited Role for Coronary Revascularization No randomized trials had assessed the benefit of prophylactic coronary revasularization to reduce the perioperative risk of noncardiac surgery.

22. Patients with Coronary Stents

24. Conclusions

25. In general, indications for further cardiac testing and treatments are the same as in non-operative setting, but their timing is dependent on several factors, including the urgency of noncardiac surgery, patient-specific risk factors, and surgery-specific considerations.

26. For many patients, noncardiac surgery represents their first opportunity to receive an appropriate assessment of both short- and long-term cardiac risk. Thus, the consultant best serves the patient by recommendations aimed at lowering the immediate perioperative cardiac risk, as well as assessing the need for subsequent postoperative risk stratification and interventions directed at modifying coronary risk factors.