Stress echocardiography may or may not be appropriate prior to noncardiac surgery.
Patient selection: no active cardiac conditions and one of the following: (1) low risk noncardiac, (2) intermediate risk noncardiac or (3) vascular surgery
(1) type of surgery
(2) functional capacity in METs
(3) number of clinical risk factors
(4) recent history
Stress echocardiography would be inappropriate if:
(1) surgery is low risk
(2) surgery is intermediate risk or vascular AND
(2a) functional capacity is >= 4 METs (moderate to good) AND no clinical risk factors
(2b) asymptomatic AND less than 1 year after a normal cardiac catheterization
(2c) asymptomatic AND less than 1 year after a normal noninvasive test
(2d) asymptomatic AND less than 1 year after a previous revascularization procedure and no active cardiac complaints
Stress echocardiography is uncertain if:
(1) surgery is intermediate risk AND (functional capacity < 4 METs or unknown)
(2) surgery is intermediate risk AND (1 or more clinical risk factors present)
Stress echocardiography is appropriate
(1) vascular surgery AND (functional capacity < 4 METs or unknown)
(2) vascular surgery AND (1 or more clinical risk factors present)
• A patient who is asymptomatic but more than a year from any of the listed conditions is not shown. Item 2d would be the most significant of these.
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