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Cardiac history is very important to assess the possibility of perioperative cardiac complications. The most important factors that have to be assessed are: cardiac reserve, history of angina pectoris or myocardial infarction and history of dysrrythmias.
1. The most striking evidence of limited cardiac reserve is a limited exercise tolerance in the absence of significant pulmonary disease. It may be adequate in patients that can climb several flights of stairs without symptoms.
2. In patients with angina pectoris, an increase in heart rate is more likely than hypertension to produce signs of myocardial ischemia.
3. If the patient has a previous myocardial infarction, the incidence of perioperative myocardial reinfarction is related to the time elapsed since the previous myocardial infarction and the amount of residual ischemia; postoperative reinfarction occurs in the first 48 to 72 hours postoperatively, with a mortality after perioperative myocardial infarction of 20-50%. The risk of myocardial reinfarction generally stabilizes at 5-6% after 6 months from the previous myocardial infarction, while infarction rate in the absence of a prior MI is lower than 0.15%.
4. Isolated premature ventricular contractions without evidence of underlying cardiac disease are not associated with increased cardiac risk. Ventricular dysrhythmias may indicate underlying cardiac disease.
5. Prior cardiac surgery or PTCA have not been associated with an increased perioperative risk. |
Cardiac disorders 
