Cardiac evaluation and care algorithm for non-cardiac surgery.

    
    ACC/AHA cardiac evaluation and care algorithm for non-cardiac surgery based on active clinical conditions, known cardiovascular disease, or cardiac risk factors for patients 50 years of age or greater. A stepwise approach to the risk assessment of patients with pre-existing cardiac disease, scheduled for surgery. Subsequent care may include cancellation or delay of surgery, coronary revascularization followed by non-cardiac surgery, or intensified care. 
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*Unstable coronary syndromes, decompensated heart failure, significant arrhythmias, severe valvular disease. 
†4 METs is roughly the activity equivalent of climbing a flight of stairs or walking on level ground at 4 miles per hour.
 ‡Clinical risk factors include history of ischemic heart disease, congestive heart failure, cerebrovascular disease, diabetes, and renal insufficiency. 
§Consider peri-operative beta-blockade.


    Cardiac risk stratification for non-cardiac surgical procedures:

 Vascular (reported cardiac risk often more than 5%)
• Aortic and other major vascular surgery
• Peripheral vascular surgery

 Intermediate (reported cardiac risk generally 1–5%)
• Intraperitoneal and intrathoracic surgery
• Carotid endarterectomy
• Head and neck surgery
• Orthopedic surgery
• Prostate surgery

 Low (reported cardiac risk generally less than 1%)
• Endoscopic procedures
• Superficial procedures
• Cataract surgery
• Breast surgery
• Ambulatory surgery

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