Which patients require cardiac clearance prior to surgery?

hypocaffeinemia, BSN, RN · Jan 27, 2009

Essentially, patients with cardiac histories, significant comorbidities, and those undergoing high-risk surgeries:

http://www.aafp.org/afp/20020915/practice.html

http://www.aafp.org/afp/20070301/656.html

These are guidelines; it is likely up to the anesthesiologist and the surgeon to decide whether or not clearance is needed.

brewerpaul · Feb 3, 2009

Even though a patient doesn't have a cardiac history, it doesn't mean that they don't have cardio issues. There are plenty of first heart attacks out there just waiting to happen. Seems like a sensible enough precaution to me-- I'd want that kind of thoroughness myself if I was going under the knife.

nursinadream · Feb 7, 2009

In the hospitals I have worked in there are clear guidelines for cardiac clearance. We have a group of nurses (PAT, pre admission testing) that do phone screenings on all patients pre-op. A list of tests and clearances have been drawn up by our anesthesia team that the PAT nurses use. Some variable factors are age, weight, hx, meds. Some patients only need medical clearance, others need cardiac clearance. Some need a chest x-ray, some need glucose or lytes drawn morning of surgery. A 30 year old healthy male without risk factor wouldn't need a medical clearance at all, just an H&P from the surgeon and a day of surgery visit by the anesthesiologist. But if this same male was 50 lbs overweight (or BMI > 40), a smoker, asthmatic and taking something for HTN, he would need a medical clearance, but still not necessarily a cardiac clearance. A patient with hx of cardiac problems and prolonged uncontrolled HTN would need a cardiac clearance. These are all based on the nurse's phone screening. Guidelines are reviewed regularly and updated as the patient population changes. I held this position about 5 years ago while working in periop setting that rotated between pre-op (holding) PACU and PAT.

Deb in KY