What are essential elements of preoperative cardiovascular risk assessment?

• A. Hair color and eye color
• B. History of CAD, MI, heart failure, arrhythmias; LVEF; functional status; current medications; and risk factors
• C. Dietary preference
• D. Favorite NFL team

Answer: (B)

In preoperative cardiovascular risk assessment, you’re looking for information that shows how well the heart is positioned to handle the stress of surgery. The most informative elements include a history of coronary artery disease, prior myocardial infarction, heart failure, and arrhythmias, because these conditions indicate underlying myocardial vulnerability and a higher chance of perioperative ischemia or rhythm problems. An objective measure of heart function, such as the left ventricular ejection fraction, provides a baseline sense of systolic performance; lower LVEF is associated with greater perioperative risk and helps tailor management. Functional status, or how well a patient tolerates physical activity (often described in METs), predicts who can endure the stress of surgery without decompensation. Current medications reveal how the patient’s treatment may interact with anesthesia and surgery, including decisions about continuing or holding beta-blockers, anticoagulants, or other cardiovascular drugs to balance risks of hypotension, bleeding, or thromboembolism. Finally, recognizing general risk factors—hypertension, diabetes, smoking, dyslipidemia, obesity, age, and kidney disease—helps gauge overall risk and guides whether further testing or optimization is needed before proceeding. Together, these elements form a comprehensive view of cardiac risk; factors like dietary preferences or unrelated personal traits do not inform cardiovascular perioperative risk.