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Cardiovascular Diseases |
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Coronary Heart Disease: ¨ Best treated under LA. ¨ Does the patient smoke, have diabetes or hypertension? ¨ What is the degree of exertion that precipitates angina or dyspnoea? ¨ Any previous heart attack? Minor surgery is relatively safe at 6 - 12 months after an ischaemic event. Check present drug treatment. ¨ Advise patient to stop smoking at least 12 hours pre-op. ¨ Perform an ECG, FBC, U&E, CXR.
Hypertension: Marked untreated hypertension (>160/110) increases preoperative mortality significantly. These patients must be stabilised on antihypertensive therapy prior to any elective surgery. Any patient with hypertension should be assumed to suffer from coronary atherosclerosis. Three spaced consistent recordings showing a diastolic > 110mmHg constitutes an unacceptably high BP.
Valvular Heart Disease: May be congenital, secondary to rheumatic fever or following valve replacement. May have cardiac insufficiency and need antibiotic prophylaxis. If possible undertake all necessary surgery at one sitting.
Angina Patients with severe or unstable angina are unlikely to be suitable for elective surgery. They should be discussed with a cardiologist. When surgery is urgent or an emergency, discuss early with anaesthetist involved.
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