The assessment of patients with cardiac disease

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The largest single cause of perioperative death is cardiac related. Cardiovascular disease affects 25% of the US population. Much work has been done to try to assess cardiovascular risk before surgery as perioperative myocardial infarction carries a 30-50% mortality. There are five main types of cardiac disease that present before surgery:

• ischaemic heart disease

• heart failure

• valvular disease

• cardiac arrhythmias especially atrial fibrillation

hypertension.

The greater the cardiovascular stress during surgery, the greater the risk of cardiac complications (Table 10.1).

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