Related Experiment Videos
How Would You Manage Perioperative Cardiovascular Risk for Noncardiac Surgery in This Patient With Complex
Howard Libman1, Avital Y O'Glasser2, Kirsten E Fleischmann3
1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (H.L., Z.K.).
Annals of Internal Medicine
|August 10, 2026
Summary
Perioperative cardiovascular management optimizes surgical risk assessment and mitigation strategies. New guidelines aid in evaluating patients undergoing noncardiac surgery, focusing on individualized care for complex cases.
Area of Science:
- Cardiology
- Internal Medicine
- Surgical Risk Management
Background:
- Perioperative cardiovascular management is crucial for patient safety during surgery.
- Risk stratification guides preoperative testing and management, preventing overscreening in low-risk individuals.
- 2024 guidelines offer evidence-based recommendations for cardiovascular risk in noncardiac surgery.
Purpose of the Study:
- To discuss the management of a complex 80-year-old patient undergoing extensive skin cancer surgery.
- To highlight the approach to preoperative evaluation and optimization in high-risk patients.
- To emphasize monitoring for cardiac complications during and after noncardiac surgery.
Main Methods:
- Systematic literature review and expert consensus formed the basis of 2024 guidelines.
- A case debate between a general internist and a cardiologist illustrates practical application.
- Focus on patient comorbidities, functional capacity, and surgical factors informs management decisions.
Main Results:
- The abstract does not contain specific results but outlines a debate on managing a complex patient.
- The discussion emphasizes a tailored approach to preoperative assessment and perioperative care.
- Key considerations include optimizing the patient's status and vigilant monitoring for cardiac events.
Conclusions:
- Effective perioperative cardiovascular management requires individualized risk assessment and mitigation.
- Expert consensus and guidelines provide a framework for complex surgical cases.
- Optimizing patient status and monitoring are essential for reducing adverse cardiac events.
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
01:23Peripheral Artery Disease V: Postoperative Nursing Management
During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
01:26Cardiac Catheterization IV: Nursing Management
Nursing responsibilities before cardiac catheterization include:Assess for allergies and establish baseline health status.Before cardiac catheterization, assess the patient for allergies to contrast dye. Perform a comprehensive baseline assessment, including vital signs, heart and breath sounds, and a neurovascular assessment of the extremities, noting distal pulses, skin color, and temperature. Instruct the patient to fast for 8-12 hours before the procedure. Evaluate baseline laboratory...
01:22Aneurysm IV: Nursing Management
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
01:29Cardiomyopathy V: Interprofessional Care
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
01:29Cardiomyopathy VI: Nursing Management
Assessment: Nursing management of patients with cardiomyopathy begins with a thorough assessment of the patient's history, including a family history of cardiomyopathy or sudden cardiac death, personal history of heart disease, hypertension, diabetes, and any alcohol consumption or drug use.During the physical examination, assess vital signs, look for signs of heart failure (such as edema, jugular venous distention, and cyanosis), auscultate for abnormal heart sounds (like murmurs and gallops),...