General Medical Information

Cardiovascular Disorders

David M. Barrs

In asymptomatic patients, a routine electrocardiogram (ECG) is recommended for men over 40 and women over 55 years. Cardiac evaluation should be done before surgery for patients with cardiovascular symptoms such as chest pain, dyspnea on exertion, palpitations, orthopnea, edema, or a history of ischemic heart disease, especially with unstable angina or a myocardial infarction within the preceding 6 months, congestive heart failure, valvular heart disease, arrhythmias, or hypertension. Besides a thorough history and physical examination, a preoperative ECG should be obtained and compared with any previous ECG tests. A chest radiograph, pulmonary function tests, and arterial blood gases are performed to estimate cardiopulmonary function. If the patient is taking cardiac medications (e.g., digitalis), serum levels should be obtained to ensure optimal levels before surgery. Electrolytes like potassium and calcium should be measured to attempt to decrease the likelihood of perioperative arrhythmias.