Cardiology>>>>>Assessment for Surgery
Question 1#

A 75-year-old man is referred for elective preoperative assessment. He is a smoker with a 40 pack-year history and diet-controlled diabetes. Baseline blood tests including renal function are normal.

Which one of the following factors would make you consider that further investigation was needed to assess his cardiac risk?

a. His planned surgery was a total hip replacement
b. His planned surgery was iliac aneurysm bypass surgery
c. His age
d. LVH on his resting ECG
e. His history of diabetes

Correct Answer is B


Vascular surgery, especially suprainguinal surgery, carries a perioperative risk of a cardiac event of >5%. High-risk surgery in the elective setting would mandate further assessment of risk, which may include non-invasive stress testing. Orthopaedic surgery is considered intermediate risk surgery. In the presence of the other individual factors, further investigation is not required since optimal medical therapy should be given. Additional risk assessment would not alter this management.