ABSTRACT
This chapter examines the risk assessment of patients presenting for non-cardiac surgery and the approach to cardiac conditions that place patients at higher risk for myocardial infarction and cardiac death: coronary artery disease and aortic stenosis. Patients with cardiac disease presenting for non-cardiac surgery are a challenge to the most senior anaesthetist. The incidence of post-operative myocardial infarction in patients undergoing non-cardiac surgery is difficult to quantify. The incidence is much higher in patients known to have coronary artery disease scheduled for vascular surgery. Patients having elective surgery will usually have attended a preoperative assessment clinic designed to identify those at high risk. Three factors interplay in the assessment of these patients: surgery-specific factors; patient-specific factors; and exercise capacity or functional status. Estimating the ejection fraction with resting echocardiography is not predictive of increased risk for perioperative ischaemia, as patients with a normal ejection fraction can have significant coronary artery disease.
