Perioperative Risk Assessment for Patients with Inferior Infarct on EKG

Preoperative Evaluation

The American College of Cardiology recommends that unstable coronary syndromes, including recent MI (particularly within 6 months), represent major risk predictors that may warrant postponing or canceling elective noncardiac surgery 1
The American Heart Association suggests that decompensated heart failure, significant arrhythmias, or hemodynamically compromising ventricular arrhythmias associated with the inferior infarct would be contraindications to elective surgery 1, 2
Active ischemia with recurrent chest pain or dynamic ST-segment changes would necessitate addressing the cardiac issue before proceeding with surgery, as recommended by the European Society of Cardiology 3

Recent inferior MI (especially within 4-6 weeks) significantly increases perioperative risk and may warrant postponing elective surgery, according to the American Heart Association 2, 4
For patients with evidence of previous inferior MI but no active symptoms, the timing since infarct is critical - risk decreases substantially after 6 months post-MI, as stated by the American Heart Association 2
The American College of Cardiology recommends that emergency surgery may still proceed despite inferior infarct if the surgical indication outweighs cardiac risk, but with intensified perioperative monitoring 4

Obtaining history to determine timing of the infarct is crucial, as recommended by the American Heart Association 2
Comparing with previous ECGs if available to determine if this is a new finding is suggested by the American Heart Association 5
Considering cardiac biomarkers (troponin) to rule out recent/acute damage is recommended by the American Heart Association 5

Patients with excellent functional capacity (>10 METs) can generally proceed to surgery despite evidence of previous inferior infarct, according to the American Heart Association 2
Poor functional capacity (<4 METs) in a patient with inferior infarct warrants further evaluation, as recommended by the American Heart Association 2

Presence of right ventricular involvement with inferior MI increases risk, as stated by the American College of Cardiology 6
Diabetes mellitus, renal insufficiency, or other comorbidities in addition to the inferior infarct increase perioperative risk, according to the American College of Cardiology and the European Society of Cardiology 1, 3

Patients with previous inferior infarct should have continuous ECG monitoring during and after surgery, as recommended by the American Heart Association 5
Serial postoperative ECGs are recommended, especially in the first 48 hours after surgery, according to the American Heart Association 5
Postoperative troponin monitoring may be valuable in patients with previous inferior infarct, as suggested by the American Heart Association 5