The Patient With Heart Disease as a Surgical Risk

A physician is often asked by his patient or his surgical confrères whether a particular person can undergo an operation. By this is generally meant whether the heart or circulation is good enough to withstand the shock and trauma of an anesthetic, and the manipulation of major surgical procedures. Although this question seems to imply a single responsibility on the part of the physician, the problem is by no means so simple. To be of greatest service to a patient under these circumstances, the internist must ask himself three questions. First, is the condition, to begin with, a surgical one? There are situations, not at all infrequent, in which circulatory disturbances present features closely resembling an acute surgical emergency. Sufficient emphasis has already been placed in recent years1on the similarity in the symptomatology and physical observations between an acute coronary thrombosis with abdominal pain and conditions such as