Key components for preoperative cardiac risk assessment

Patient related
History
Prior cardiac disease	Previous MI: recent (<2 months); remote Angina (stable?/NYHA Class) HF (systolic/diastolic/symptoms/EF) Arrhythmias/pacemaker/ICD Valvular disease (AS/MS, severity, symptoms)
Prior cardiac intervention	CABG PCI (BA, BMS, DES) What? When? Recurrent symptoms?
Prior cardiac evaluation (diagnostic tests)	ECG Stress test (exercise, with or without imaging; pharmacologic, with echo or nuclear imaging) Echo Angiography or CCTA
Risk factors for CAD	Age Male sex HTN DM Dyslipidemia Smoking
Comorbidities associated with CAD	CVA PAD CKD COPD OSA
Current symptoms	Chest pain Dyspnea Functional status (independent?) Exercise capacity (>4 METs, 2 flights of stairs?) DASI score
Cardiovascular medications	Antiplatelet Beta blocker ACEI/ARB Nitrates Other antianginal or antihypertensive Statin Anticoagulant
Physical examination
BP Heart rate and regularity RR (tachypnea) JVD Murmur S3 Rales Edema
Biomarkers
BNP Troponin
Surgery related
High risk: Major vascular (AAA, suprainguinal bypass) Major procedures with significant blood loss or fluid shifts Intermediate risk: Intraperitoneal Intrathoracic (non-major) CEA, endovascular surgery Major orthopedic Emergency surgery

MI: myocardial infarction; NYHA: New York Heart Association; HF: heart failure; EF: ejection fraction; ICD: implantable cardioverter-defibrillator; AS: aortic stenosis; MS: mitral stenosis; CABG: coronary artery bypass graft; PCI: percutaneous coronary intervention; BA: balloon angioplasty; BMS: bare metal stent; DES: drug-eluting stent; ECG: electrocardiogram; CCTA: coronary computed tomography angiography; HTN: hypertension; DM: diabetes mellitus; CVA: cerebrovascular accident; PAD: peripheral artery disease; CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; OSA: obstructive sleep apnea; METS: metabolic equivalents; DASI: Duke Activity Status Index; ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; BP: blood pressure; RR: respiratory rate; JVD: jugular venous distention; BNP: brain natriuretic peptide; AAA: abdominal aortic aneurysm; CEA: carotid endarterectomy.

Reproduced with permission from: Cohn SL. Ischemic heart disease. In: Decision Making in Perioperative Medicine: Clinical Pearls, Cohn SL (Ed), McGraw Hill 2021. Copyright © 2021 McGraw Hill. McGraw Hill makes no representations or warranties as to the accuracy of any information contained in this McGraw Hill material, including any warranties of merchantability or fitness for a particular purpose. In no event shall McGraw Hill have any liability to any party for special, incidental, tort, or consequential damages arising out of or in connection with this McGraw Hill material, even if McGraw Hill has been advised of the possibility of such damages.

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Key components for preoperative cardiac risk assessment