Synopsis
Estimate cardiovascular risk before non-cardiac surgery, identify conditions that need treatment or delay, and plan proportionate investigation, medicines and postoperative surveillance.
- Start with surgical urgency: emergency treatment must not be delayed by tests that cannot change immediate management.
- Estimate both procedure-related risk and patient-related risk; previous cardiovascular disease, symptoms, frailty, renal disease and diabetes materially alter risk.
- New chest pain, decompensated heart failure, unstable arrhythmia or severe symptomatic valve disease requires assessment before elective surgery proceeds.
Key red flags
New or crescendo exertional chest pressure, rest pain, dynamic ECG change or a recent acute coronary syndrome needs urgent evaluation rather than elective anaesthesia.
Investigation priorities
Establish rhythm and identify conduction disease, previous infarction or ischaemic change when indicated by age, ASA grade, comorbidity and surgical magnitude.
Management branches
Any patient being considered for non-cardiac surgery.
- Classify the procedure as emergency, urgent, time-sensitive or elective and estimate its physiological and bleeding burden.
- Ask specifically about chest pain, dyspnoea, orthopnoea, syncope, palpitations, recent vascular events and change in exercise tolerance; examine cardiovascular status.