Preparation and Cardiac Evaluation of a patient before GI Surgery
Cardiovascular complications and Myocardial Infarctions are common cause of death in the immediate postoperative period. Their incidence can be as high as 50% of all the perioperative deaths. Patients with coronary artery disease (CAD) have increased stress after surgery and have difficulty in maintaing blood flow to the coronary arteries.
Patients can be divided into having
low risk - <1% incidence of death
Intermediate risk -1-5 % risk of death
High risk- > 5%
Most of the GI Surgery cases come intermediate risk.
Patients with unstable angina (USA), heart failure (HF), severe valvular stenosis, and significant arrhythmias are also at high-risk for a perioperative cardiovascular event.
Evaluation begins with
Further more if a patient has any of these--\
*Unstable Cardiac Angina
*Decompensated Heart Disease
*Severe Valvular disease
He is to be evaluated Further with
(i) Cardiac Stress testing - It can be performed with exercise, vasodilators and adrenregic stimulation in combination with radionuclide testing or echocardiography.
"Trials such as CARP and DECREASE-V suggest that postoperative outcome is unchanged by prophylactic coronary revascularization in stable patients"