Why Was I Referred to a Cardiologist Prior to My Surgery?
In cardiology, we refer to preoperative evaluations as preoperative risk stratification. What the cardiologist must know (also your surgeon, PCP, anesthesiologist) is what is the likelihood of you suffering a cardiac complication (heart attack, arrhythmia, etc.) during or after your surgery.
What is the Purpose of Preoperative Risk Stratification?
Patient safety: We are trying to keep you as safe as possible during and around the time of surgery. Most heart attacks occur within 3 days of surgery, not necessarily, in the operating room. You may have no complaints in your daily activities, but under the stress of surgery/anesthesia suffer a cardiac complication. We need to know you can handle the rigors of surgery and anesthesia.
Medicolegal: Malpractice suits related to cardiac complications in patients undergoing noncardiac surgery are among the most common filed against surgeons. Why? It’s because you were informed of surgical related risks of a procedure, but not informed you might die of a heart attack.
Stratification: Using Common Sense.
If you are generally healthy, have none or very few cardiac risk factors, and are actively exercising without complaints, younger in age…your chances of suffering a heart attack or heart related complication during the time of your surgery is very low. In such patients it is possible to proceed to even more strenuous surgeries without cardiac testing. The same holds for patients who are undergoing low risk procedures such as cataract surgery, breast biopsy, EGD/colonoscopy, etc. All of this is common sense.
However, if you have significant risk factors for heart disease such as DM, HTN, hypercholesterolemia, are older in age and sedentary—even without symptoms--you should undergo cardiac testing. If you have an abnormal EKG, you should be evaluated. Obviously, if you have any symptoms related to exercise—chest discomfort, shortness of breath, edema, palpitations, etc.--you require preoperative testing.
Type of Surgery:
The type of surgery is important. Surgeries which involve the chest cavity, abdominal cavity, or blood vessels are considered higher risk. These procedures are more taxing on your body.
Type of Anesthesia:
General anesthesia is more taxing on the body than local or regional anesthesia. For example, in my career, I have evaluated patients who suffered a cardiac arrest yet the surgeon has not even started the procedure—due to complications arising from anesthesia.
Preoperative Testing:
Stress testing and Echocardiography. Such basic testing is standard. See my post on ‘stress test and echo’. Once we know that the structure and function of your heart is sound, the risk of suffering a cardiac complication from surgery is low.
Surgical Delays:
As much as possible, your cardiologist does not want to delay your procedure. Most patients undergoing noncardiac surgery have no cardiac complications. A rare minority do, however, and suffering a heart attack related to surgery can be fatal/devastating. It is these few patients which we are searching for.
Often it becomes frustrating to the patient, their family and even the surgeon and anesthesiologist when the cardiologist delays a procedure for cardiac testing. I recommend that all patients follow the advice of their cardiologist. If your cardiologist recommends a test, medication or procedure, follow your doctor’s advice. They have your best interest in mind.
Note: Understanding your heart condition is not difficult. Patients become frustrated and confused when doctors don’t explain things clearly. If you don’t understand what your doctor is talking about, then you won’t be able to ask meaningful questions. I hope that my posts provide you with a framework that you can build upon to become an active participant in your healthcare.
Stay Healthy!
Gregg Yamada MD FACC
Disclaimer: I hope you find my medical blogs to be pertinent, interesting, thought provoking, and even humorous. The information provided is educational and should not be taken as medical advice. I am a doctor, but I am not your doctor. Please schedule an appointment with your doctor to discuss these issues and to determine what is right for you.
© 2020. Gregg M. Yamada, MD FACC. All rights reserved.