Predicting cardiac risk in peri-operative setting

Question 1

what are some factors from history that would increase cardiac risk in operative patients

(non-CTS surgery)

Answer 1

see the image

but essential, you add up the risk factors to predict.

once you get beyond 3 factors, it’s bad news bears

this test is called the Revised Cardiac Risk Index

Question 2

in pre-operative work up, what is the role for coronary revascularisation?

Answer 2

there aren’t any clear extra indications pre-operative.

the decision for any intervention should rest on proven indications in the non-operative setting

(ACS or severe refractory ischaemia)

Question 3

a patient has had a CABG 2 years ago, is asymptomatic from cardiac perspective and presents for THR.

what investigations should be done?

what about if the patient has known disease, but had a stress test 6 months ago which was normal?

Answer 3

there is no role for further testing in patients with coronary revasc within past 5 years provided NO RECURRENT SYMPTOMS

similarly for any negative cardiac evaulation within last 2 years