Anesthesia in the heart patient for noncardiac surgery

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There is a small hazard for every patient who is given anesthesia and undergoes an operation. If the patient also has cardiovascular disease, the surgical event may be likened to an uncontrolled stress test associated with significant morbidity and mortality. That most patients with severe heart disease survive even the most major surgical procedures is a credit to the modern management of anesthesia and supportive care.

Since approximately 5% of the adult population of the United States have ischemic heart disease, most practicing anesthesiologists must regularly manage the problem. To do this safely, we must recognize those at increased risk and be cognizant of the hazards related to anesthesia and operation. Preoperatively these patients must be assured that they are in the best state possible. In the preoperative and postoperative periods they need special care and attention.

Recognition and evaluation of ischemic disease

Recognition is often difficult, and a high index of suspicion must be maintained. Many patients with severe ischemic disease are asymptomatic with no positive history. Fifteen percent to 20% of myocardial infarctions may be painless1 and undiagnosed at that time. An important aid to the diagnosis of occult disease is the coronary risk profile, which includes obesity, hypertension, diabetes, familial hyperlipidemia, stress, and smoking. Ischemic heart disease is more common from the fifth decade onward, but a considerable incidence of coronary occlusion occurs in the 30- to 40-year-old group. A careful history, physical examination, and investigation are essential for accurate recognition and evaluation.

History. Angina pectoris may . . .



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