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ACC/AHA
Guideline Update for Perioperative Cardiovascular Evaluation
for Noncardiac Surgery
A
Report of the American College of Cardiology/American
Heart Association Task Force on Practice Guidelines
(Committee to Update the 1996 Guidelines on Perioperative
Cardiovascular Evaluation for Noncardiac Surgery)
(Printer-friendly
version)
Revised
Table 1. Clinical
Predictors of Increased Perioperative Cardiovascular
Risk (Myocardial Infarction, Heart Failure, Death)
Major
Unstable coronary syndromes
- Acute
or recent MI* with evidence of important ischemic
risk by clinical symptoms or noninvasive study
- Unstable
or severe† angina (Canadian Class III or IV)‡
Decompensated
heart failure
Significant arrhythmias
-
High-grade atrioventricular
block
-
Symptomatic ventricular arrhythmias in the presence
of underlying heart disease
-
Supraventricular arrhythmias with uncontrolled ventricular
rate
Severe
valvular disease
Intermediate
Mild angina pectoris (Canadian Class I or II)
Previous MI by history or pathological Q waves
Compensated or prior heart failure
Diabetes mellitus (particularly
insulin-dependent)
Renal insufficiency
Minor
Advanced age
Abnormal ECG (left ventricular hypertrophy, left bundle-branch
block, ST-T abnormalities)
Rhythm other than sinus (eg, atrial fibrillation)
Low functional capacity (eg, inability to climb one
flight of stairs with a bag of groceries)
History of stroke
Uncontrolled systemic hypertension
ECG
indicates electrocardiogram; MI, myocardial infarction.
*The American College of Cardiology National Database
Library defines recent MI as greater than 7 days but
less than or equal to 1 month (30 days);
acute MI is within 7 days.
†May include "stable" angina in patients who are unusually
sedentary.
‡Campeau L. Grading of angina pectoris. Circulation.
1976;54:522-523.
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