ABSTRACT
Cardiac disease is common in developed countries and is becoming common elsewhere in the world (1). In the West, people are living longer and so have greater opportunity to develop coronary artery disease (CAD) or heart failure rather than being carried off by other diseases. Elsewhere in the world, the scourge of tobacco is causing new epidemics of CAD (2). The surgical population has become older and sicker. Surgery, anesthesia, and perioperative care have also advanced. Cancers that were thought to be untreatable are now amenable to combined surgical and chemoor radiotherapy. Newer anesthetic agents have less effect on the heart and circulation. Sophisticated monitoring, fluid management, and inotropic drugs allow the circulation to be supported during and after surgery. It has become possible to perform operations on patients who 10 or 15 years ago were considered too old or unfit to withstand surgery. It is now felt reasonable to operate on high-risk patients, including those with heart disease, and the benefits to the patient may be substantial (3). However, the risks can also be substantial.
