ABSTRACT

Angina and dyspnea feature commonly and must be assessed both in their severity and trend. Overall quality of life remains a major determinant of need for surgical intervention. Symptoms of heart failure, palpitations and syncope alert clinicians to possible sequelae of underlying cardiac disease. Other atherosclerotic complications manifestating as cerebrovascular events and lower limb ischemia should be screened for. Documentation of risk factors for coronary artery disease (smoking, hypertension, diabetes, hypercholesterolemia and family history) and valvular heart disease (rheumatic fever, bacteremic events) is important. Smokers should be persuaded to stop at least 6 weeks prior to surgery to reduce respiratory complications. Identification of important comorbidities from past medical history is vital to the decisions on whether to operate and on the optimal surgical approach. A bleeding diathesis or hemorrhagic risk (e.g. peptic ulceration) may preclude systemic anticoagulation and hence the institution of cardiopulmonary bypass or implantation of mechanical prosthesis. A knowledge of regular medications, cardiotropic or otherwise, and any specific allergy is helpful to perioperative management. It is common to withdraw aspirin preoperatively for 7 days to minimize postoperative bleeding. Similarly warfarin may be omitted 3 days before surgery, and heparin commenced if necessary in hospital. Otherwise most regular medications including all anti-anginal, anti-hypertensive, diuretic and anti-arrhythmic

drugs should be continued until surgery to avoid perioperative compromise. Symptoms of concurrent infection (viral or bacterial) alert the clinician to increased risks of postoperative respiratory, wound and prosthesis-related complications. An understanding of the social circumstances would facilitate more efficient discharge planning.