Cardiac complications following major surgery are relatively common. Specifically assessing an individual’s cardiac risk prior to surgery is important but there is no perfect scoring system or test. There are useful tools and test that can help quantify risk.
At York Teaching Hospital we are currently assessing a patient’s cardiac status and risk through cardio-pulmonary exercise testing and the Revised Cardiac Risk Index.
If the anaesthetist finds significant risk the patient is referred on to cardiology, who may perform echocardiography.
Patients at significant cardiac risk will mostly be put onto our enhanced perioperative pathway which facilitates the use of pulse contour analysis cardiac monitoring and haemodynamic optimisation protocols in the post-operative period.
- Patients that have evidence of significant ischaemic at cardio-pulmonary exercise testing or symptomatic heart failure should be referred to cardiology.
- Current cardiac medications should be reviewed and consider the need for asprin, statins and beta-blockade.
- There may be some value in using biomarkers such as BNP to assess cardiac risk