Preoperative assessment of cardiac patients undergoing noncardiac surgical procedures.

A careful clinical history and physical examination are the most important components of the preoperative assessment of the cardiac patient who is to undergo a noncardiac surgical procedure. From these factors and the nature of the surgical procedure planned, a reasonable estimate of potential cardiac risk can be formulated to guide judicious preoperative testing for further definition of potentially high-risk patients. The potential risks associated with an invasive cardiac procedure or surgical intervention must always be considered along with the potential benefits of such a procedure in an attempt to reduce the cardiac risk of noncardiac operations. Aggressive and conscientious preoperative assessment and perioperative care of the high-risk patient by the concerted efforts of the medical consultant, anesthesiologist, and surgeon may substantially diminish cardiac-related morbidity and mortality during noncardiac surgical procedures.