Assessment of Cardiac Risk in Surgical Patients

Patterns of Oxygen Consumption during Exercise Testing in Peripheral Vascular Disease

“…This is not only demon strated by the lack of a plateau, but by the lower heart rate and lower respiratory ex change ratio. The lack of predictability of exercise testing for complications during surgery has been reported [1], An alterna tive approach is to use arm exercise, but this provides only modest improvement [10]. On the other hand, in a subject with peripheral vascular disease, if signs and symptoms of ischemia develop during excercise, this usually implies severe disease.…”

“…The util ity of exercise testing in this situation has been questioned [1], Despite this limitation exercise testing is often performed to evalu ate the severity of disability in patients with peripheral vascular disease and evaluate the effect of therapy. Most studies have not re ported measurement of oxygen consumption during exercise testing.…”

Assessment of cardiac risk before non-cardiac surgery: brain natriuretic peptide in 1590 patients

“…The presence of poor left ventricular systolic or diastolic dysfunction may predictive perioperative cardiac events. [3][4][5][6][7][8][9] Symptoms of heart disease may be absent or blunted in patients limited by orthopaedic, pulmonary or other superimposed disability. Clinical evaluation alone, therefore, may be insufficient to risk stratify patients with such limitations, and clearly there is room for improvement in diagnosis.…”

Anaesthesia for abdominal aortic surgery — a review (Part I)

“…63 Cutler et al ~4-65 noted that 30 per cent of these patients, with no previous history of myocardial infarction or angina and with a normal ECG, will manifest an ischaemic response during or following exercise. Proponents of exercise testing claim that an ischaemic response -defined as 1 mm or greater ST segment depression, arrhythmia or intractable angina -is a useful predictor of periopertive cardiac complications.…”