Perioperative Cardiac Assessment for Non-Cardiac Surgeries

Step-by-Step Approach to Perioperative Cardiac Assessment

• The American College of Cardiology and American Heart Association recommend a stepwise approach to perioperative cardiac assessment, focusing on identifying patients at elevated risk while avoiding unnecessary testing in low-risk scenarios 1, 2
• For emergency surgery, the American College of Cardiology and American Heart Association suggest proceeding with appropriate monitoring and management based on clinical assessment 2
• The American College of Cardiology and American Heart Association recommend screening for unstable coronary syndromes, such as unstable or severe angina, and recent myocardial infarction, as part of the stepwise approach 4, 5
• Assessing for decompensated heart failure, significant arrhythmias, and severe valvular disease is also recommended by the American College of Cardiology and American Heart Association as part of the stepwise approach 4, 5
• The American College of Cardiology and American Heart Association suggest using tools like the American College of Surgeons NSQIP risk calculator or the Revised Cardiac Risk Index to estimate perioperative risk 2, 7

Supplemental Preoperative Evaluation Recommendations

• The American College of Cardiology and American Heart Association recommend a 12-lead ECG for patients with known coronary heart disease, significant arrhythmia, peripheral arterial disease, cerebrovascular disease, or other significant structural heart disease, except for low-risk surgery 1, 3
• The American College of Cardiology and American Heart Association suggest assessing left ventricular function in patients with dyspnea of unknown origin or heart failure with worsening dyspnea or changed clinical status 1, 6

Perioperative Monitoring Recommendations

• The American College of Cardiology and American Heart Association recommend ST-segment monitoring for patients with known coronary artery disease or those undergoing vascular surgery 4
• The American College of Cardiology and American Heart Association suggest troponin monitoring in patients with ECG changes or chest pain typical of acute coronary syndrome 4