الفهرس 
Clinical Assessment of Ischemic Heart Disease PatientOnly 14 pages are availabe for public view
 |  | from | 126 |  |  |
| | | from | 126 | | |
Abstract
Successful perioperative evaluation and management of high-risk cardiac patients undergoing noncardiac surgery requires careful teamwork and communication between surgeon, anesthesiologist, and the patient’s primary caregiver.
First step is to determine the clinical risk factors by taking full medical history especially the presence of unstable coronary syndromes, Decompensated Heart failure, significant arrhythmias, severe valvular disease, Pulmonary, renal, endocrinal, and hematological diseases then determine the functional capacity of the patient.
In general, indications for further cardiac testing and treatments are the same as in the nonoperative setting, but their timing is dependent on several factors, including the urgency of noncardiac surgery, patient-specific risk factors,surgery-specific considerations anesthetic considerations. The use of both noninvasive and invasive preoperative testing should be limited to those circumstances in which the results of such tests will clearly affect patient management.
Cardiac complications after non-cardiac surgery depend not only on patient specific risk factors but also on the type of surgery and the circumstances under which it takes place and anesthetic managment.
Preoperative cardiac evaluation may lead to interventions those lower perioperative risk, decrease long-term mortality, or alter the surgical decision-making process. Such alterations might include either choosing a lower-risk, less invasive procedure or electing to follow up rather than to operate or choosing nonoperative treatment.
For many patients, noncardiac surgery represents their first opportunity to receive an appropriate assessment of both short- and long-term cardiac risk. Thus, the consultant best serves the patient by making recommendations aimed at lowering the immediate perioperative cardiac risk, either by pharmacological agents like b- blockers, statins, α2-agonist and others ,or by more invasive procedures or surgery like CABG as well as assessing the need for subsequent postoperative risk stratification and interventions directed at modifying coronary risk factors.
Post operative Surveillance and Pain Management play a major role in improving the perioperative outcomes and must be included in the perioperative plan.
Future research should be directed at determining the value of prophylactic medical therapy versus more extensive diagnostic testing and interventions.