ABSTRACT
The stress of major surgery can lead to increased oxygen demand by up to 40%. Inflammatory changes due to cytokine release, endocrine responses, hypercoagulability and redistribution of fluid between compartments may last several postoperative days. Systematic history taking, examination and investigation at the preoperative clinic should include not only an assessment of functional reserve but also the formulation of advice on optimisation, to best cope with the anticipated operative stress. Left ventricular failure is the end result of several conditions, including IHD, hypertension, cardiomyopathies and valve dysfunction. Primary percutaneous intervention is the treatment of choice for acute coronary syndromes, and many patients receive stents and are on dual antiplatelet therapy for 12 months. An echo is required in symptomatic patients with a new murmur.
