Perioperative Cardiac Morbidity

Ischemic heart disease (IHD) can be complex in its clinical presentation. The patient with IHD usually has one of the many symptom complexes associated with varying degrees of ventricular dysfunction. As anesthesiologists, our assessment of a patient with IHD presenting for surgery is usually conducted over a very brief period of time and, therefore, requires a rather intense assessment of the patient’s cardiac status. Several other factors add to the difficulties involved in this assessment: 1) The age of the population presenting for surgery is increasing; 2) surgical procedures are becoming more complex; and 3) cost containment procedures will limit the number and type of preoperative tests used to assess risk in patients with IHD, and there will be increasing pressure on us to expedite such an assessment (e.g., come-and-go, come-and-stay surgery). Thus, more than ever, we must know what specific tests are available for assessment of these patients and what information we can obtain from these tests to determine perioperative risk, preoperative therapeutics, intraoperative monitoring, choice of anesthetic, and postoperative care.