Non-cardiac surgery

Question 1

Assessment prior to non cardiac surgery

Answer 1

• FHx of genetic cardiomyopathy - ECG and echo prior to NCS
• > 65 with CV risk factors, irrespective of symptoms, consider ECG biomarkers prior to surgery
• New murmur suggesting clinically significant pathology or other symptoms signs of cardiovascular disease - echo prior to NCS. If isolated murmur, no symptoms or signs, consider echo
• Angina needing elective NCS - further work up before NCS. Angina needing acute NCS - MDT approach
• Dyspnoea or peripheral oedema - ECG and NT-proBNP prior to surgery. If NT-proBNP raised, TTE prior to surgery

Question 2

Low / intermediate / high surgical risk

Answer 2

Question 3

Echo recommendations before NCS

Answer 3

Question 4

Stress Imaging recommendations before NCS

Answer 4

Question 5

Pharmacological recommendations

Answer 5

Question 6

Management of DAPT in NCS

Answer 6

Question 7

DAPT in NCS - recommendations

Answer 7

Question 8

OAC in NCS - recommendations

Answer 8

Urgent NCS needing reversal of NOAC:
Dabigatran - Idarucizumab
Apixaban and Rivaroxaban - Andexenet Alpha
If not available PCC

Question 9

Interruption of OAC in NCS- recommendations

Answer 9

Question 10

Management of ACS or CCS in patients needing NCS

Answer 10

Question 11

Rhythm management prior to NCS

Answer 11

Question 12

Management of peri-operative MI

Answer 12

Question 13

Post operative complications

Answer 13

AVOID routine preoperative betablockers to prevent AF (consider in cardiac surgery and oesophageal surgery)

Question 14

Pre-operative Management - Diabetes and HTN

Answer 14

• In diabetics, check HbA1c pre-op NCS
• In elective surgery, if HbA1c ≥8.5% - postpone surgery if safe and practical
• If having intermediate or high risk NCS and DM with TOD or established CAD, assess for concomitant cardiac conditions
• Don’t postpone surgery for Grade 1 and 2 HTN. Do postpone for Grade 3 unless emergency
• If HF - continue RAAS
• If non-HF - hold RAAS on day