Certain conditions are associated with an increased risk for an adverse perioperative cardiovascular event.


Perioperative cardiovascular events include:

(1) myocardial infarction

(2) congestive heart failure

(3) sudden death


Predictor of Perioperative Cardiovascular Event

major predictors

unstable coronary syndrome


decompensated congestive heart failure


serious arrhythmias


severe valvular disease

intermediate predictors

mild angina pectoris (Canadian Class I or II)


prior myocardial infarction by history or pathological Q waves


compensated or prior congestive heart failure


diabetes mellitus

minor predictors

advanced age


abnormal electrocardiogram


rhythm other than sinus (atrial fibrillation, etc.)


low exercise tolerance


history of stroke


uncontrolled systemic hypertension



• Unstable coronary syndromes include recent myocardial infarction with evidence of important ischemic risk from clinical symptoms or noninvasive study, and unstable or severe angina (Canadian Class III or IV).

• Serious arrhythmias include high grade atrioventricular block, symptomatic ventricular arrhythmias in the presence of underlying heart disease, supraventricular arrhythmias with uncontrolled ventricular rate.

• Abnormal electrocardiogram includes ventricular hypertrophy, bundle branch block, or ST-T wave abnormalities.

• Uncontrolled systemic hypertension may be associated with marked changes in blood pressure during and after surgery, with associated myocardial ischemia.


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