Question 26

A 55 yo patient with no significant past medical history presents with postmenopausal bleeding and is scheduled to undergo an operative hysteroscopy for an endometrial polyp. She plays tennis twice weekly. Her perioperative cardiac evaluation should include:

Answer Choices:

Chest X-ray

Echocardiography

Electrocardiography (ECG)

Exercise stress testing

No testing

Correct Answer:

No testing

Explanation:

  • The American College of Cardiology and American Heart Association have a joint guideline on perioperative cardiovascular evaluation and management of patients undergoing non-cardiac surgery

  • A low-risk procedure is when the surgical and patient characteristics predict a risk of major adverse cardiac event as less than 1%.

  • Elevated-risk procedures have 1% or greater risk of major cardiac adverse effect.

  • Risk calculators are available online (include questions about cardiovascular disease, diabetes and cerebrovascular disease)

  • Functional status is a reliable predictor of perioperative and long-term cardiac events. In highly functional asymptomatic patients, it is often appropriate to proceed with surgery without further cardiovascular testing. There are also online tools to determine functional status.

  • Pre-op ECG is reasonable for patients with known coronary heart disease or other structural heart disease (though not technically needed for low-risk surgeries)

  • Routine pre-op ECG is not useful for asymptomatic patients undergoing low-risk procedures

  • Chest x-rays rarely find clinically relevant new information