Noncardiac surgery in the elderly patient with cardiovascular disease

The elderly patient with cardiovascular disease who undergoes noncardiac surgery presents a challenge to the medical-surgical team. A high prevalence of cardiac disease necessitates a preoperative in-depth search for the presence of cardiovascular risk factors and their reversal if possible. Aging is associated with an altered physiologic response to the stress of surgery as well as to anesthetic agents and perioperative medications, requiring that the elderly patient often be treated quite differently than the younger surgical patient. This article provides guidelines for the estimation of the risk of cardiac complication due to noncardiac surgery and discusses the identification and management of acute and chronic cardiovascular problems in the perioperative period.