Perioperative cardiac risk: pathophysiology, assessment and management.
Cardiac complications are the leading cause of perioperative morbidity and mortality following noncardiac surgery. The annual cost of perioperative cardiovascular events exceeds 20 billion US dollars. A strategic preoperative evaluation holds the potential to reduce perioperative cardiac events and healthcare costs; however, our current understanding of the pathophysiological basis of postoperative acute coronary syndromes is limited. Although significant advances continue to facilitate early and reliable noninvasive detection of high-risk coronary anatomy, the most appropriate interventions remain unclear. Pharmacotherapy, revascularization, safer anesthesia and early detection of perioperative heart failure may all reduce perioperative morbidity and mortality, although the evidence base is incomplete and controversial. A close working relationship between the primary care physician, cardiologist, surgeon and anesthesiologist will facilitate rational, tailored and optimized management decisions that constitute our best opportunity to reduce perioperative cardiovascular risk.
Sista
Ramachandra R
RR
Stanford University, Division of Pulmonary and Critical Care Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA. sista@pol.net
Ernst
Kavita V
KV
Ashley
Euan A
EA
D006331:Heart Diseases / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D011322:Primary Prevention / Q000379:methods; D018570:Risk Assessment; D040242:Risk Reduction Behavior; D013514:Surgical Procedures, Operative / Q000009:adverse effects*