Diagnosis
6
Table 1. Preoperative Cardiac Evaluation for the Patient
Undergoing Aneurysm Repair
1. Is there an active cardiac
condition?
• Unstable coronary syndrome
• Unstable or severe angina
• Recent myocardial infarction (MI) (<1 month)
• Decompensated congestive heart failure (CHF)
• Significant arrhythmias
• Severe valvular disease
Presence cancels or delays aneurysm repair until
conditions are treated. Implement medical
management and consider coronary angiography.
2. Does the patient have good
functional capacity without
symptoms?
• MET ≥4 (Table 2)
• Clinical risk factors
• Mild angina pectoris
• Prior MI
• Compensated or prior CHF
• Diabetes mellitus
• Renal insufficiency
May proceed with aneurysm repair. In patients with
known cardiovascular disease or at least one clinical
risk factor, beta blockade is appropriate.
3. Is functional capacity poor
or unknown?
• MET <4 (Table 2)
• Clinical risk factors
• Mild angina pectoris
• Prior MI
• Compensated or prior CHF
• Diabetes mellitus
• Renal insufficiency
In patients with three or more clinical risk factors,
preoperative noninvasive testing is appropriate if it
will change management.
From: Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, et al. e care
of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines.
J Vasc Surg. 2009;50(Suppl):S2-49; originally adapted from Fleisher LA, Beckman JA, Brown
KA, Calkins H, Chaikof E, Fleischmann KE, et al. ACC/AHA 2007 guidelines on perioperative
cardiovascular evaluation and care for noncardiac surgery: executive summary. Circulation
2007;116:1971-96.
