Practical approaches to cardiac clearance in nontraditional clinical scenarios

Area of Science:

• Cardiology
• Internal Medicine
• Medical Decision Making

Background:

• Many non-cardiac procedures and activities lack established guidelines for cardiovascular risk evaluation.
• Previous work identified six "nontraditional" requests for cardiovascular risk assessment.
• The authors continue to receive novel and complex referral requests.

Purpose of the Study:

• To review the literature and provide management recommendations for six additional "nontraditional" cardiovascular risk evaluation scenarios.
• To address emerging therapies and activities prompting cardiac clearance inquiries.
• To guide clinicians in patient-centered cardiovascular risk assessment.

Main Methods:

• Literature review of existing evidence for specified non-cardiac procedures and activities.
• Analysis of real-world referral cases received by the authors.
• Development of management recommendations based on physiological principles and available data.

Main Results:

• Recommendations are provided for hyperbaric oxygen therapy, ketamine therapy, antipsychotic therapy, and proton therapy to the chest.
• Cardiovascular risk evaluation considerations for law enforcement officers and bowling are discussed.
• The need for a standardized, patient-centered approach is reinforced.

Conclusions:

• A systematic approach to cardiovascular risk evaluation is crucial for diverse clinical scenarios.
• Understanding the procedure, physiology, and literature is key to informed decision-making.
• This work expands guidance for "nontraditional" cardiovascular risk evaluations.