Preoperative cardiac risk stratification and management

Perioperative myocardial infarction carries an increased short and long-term morbidity and mortality. The perioperative cardiac evaluation should focus on obtaining critical data such as type of surgery, patient co-morbidities, functional capacity of the patient, medications used and exclusion of active cardiac conditions. With this information the physician should stratify the patient according to the latest American College of Cardiology/American Heart Association guidelines and recommend interventions to decrease myocardial infarct risk. The interventions include: coronary revascularization (e.g. angioplasty, coronary artery bypass graft) and/ or pharmacological therapy (e.g. Beta-blockers, statins, etc.). All this information should be documented and discussed among the perioperative physicians (surgeon, anesthesia, primary physician, cardiologist) in order to provide the optimal care of the patient. The management of other cardiac conditions such as valvular disease, hypertension, heart failure, cardiac arrhythmias and cardiac devices are not contemplated in this narrative review.