Guidelines help patients reduce risk of cardiac event befo...(patient should go straight to an operati...),Health

The guidelines recommend that patients undergo evaluation and treatment before noncardiac surgery only for active cardiac conditions such as unstable coronary syndromes (severe angina), decompensated heart failure, significant heart rhythm disturbances (arrhythmias) or severe heart valve disease.

Previously, to have someone ready for surgery, many people needed diagnostic tests to look at the extent of heart disease, said Fleisher, chair of the Department of Anesthesiology and Critical Care at the Hospital of the University of Pennsylvania. We would do a lot of screening, and we might fix their heart disease to get them ready for the noncardiac surgery. We know now that surgical outcomes are the same in many people whether or not we fix the heart disease first.

The difference in whether heart procedures reduce the risk of surgery is whether a persons heart disease is either severe or symptomatic both of which would require treatment regardless of the impending surgery. Several trials now show that in people without symptomatic heart disease, fixing the heart first doesnt make much of a difference in how well they do in surgery, Fleisher said.

Thus, the surgical setting shouldnt be the only catalyst for a heart procedure. Fleisher said angioplasty with stenting might even increase the risk of perioperative heart problems. The risk of heart attack increases in the four to six weeks immediately after receiving a stent, so patients are prescribed anti-clotting medication during this period. This risk, and the duration of anti-clotting therapy, is up to one year for patients who received a coated or drug-eluting stent.

Due to the risks of excessive bleeding common to any surgery, patients were previously advised to stop taking their anti-clotting drugs prior to surgery. We now know that the antiplatelet medication is very important after stent placement, and we advocate stopping it for as l
'/>"/>