Before non-cardiac surgery, the goal isn’t to stop operations—it’s to make them safer. A focused cardiovascular review clarifies risk, guides any optimization, and helps the whole team (surgeon, anesthesia, cardiology) plan a smooth pathway with fewer last-minute surprises and a faster recovery. Current guidelines recommend a stepwise approach: start with history and examination, consider the type of surgery, estimate risk, and only order tests if the result would change management.
The Quick Risk Conversation
- Symptoms & history: We ask about chest discomfort, breathlessness, palpitations, syncope, previous heart disease, and recent changes. Procedure urgency and surgical risk (minor vs intermediate vs major) matter too.
- Functional capacity: How far you can comfortably walk, or climb is a powerful predictor. Formal tools such as the Duke Activity Status Index (DASI) translate everyday activities into a score; values below ~34 suggest lower capacity and may justify closer evaluation for higher-risk procedures.
- Risk calculators: Indices like the Revised Cardiac Risk Index (RCRI) combine patient and procedure factors to estimate major cardiac complications. They’re a starting point—not the whole story—but they help target who benefits from further optimization.
Tests that Matter
Guidelines are clear: don’t test routinely. Use tests when results will alter the plan (e.g., delay surgery, change anesthesia strategy, start treatment).
- ECG & bloods: A resting ECG is useful when there’s known cardiovascular disease, significant risk factors, or symptoms; bloods (e.g., renal function, Hb) follow the surgical context and comorbidity. NICE gives pragmatic, procedure-based tables that help avoid unnecessary testing.
- Echocardiography: Consider if there’s new or worsening heart failure, unexplained dyspnoea, or a murmur suggesting significant valve disease—not for routine “screening”.
- Stress testing: Reserve for patients with poor functional capacity and elevated estimated risk where findings would change management (medical therapy, revascularization decisions, or surgical timing). Routine stress tests in low-risk or asymptomatic patients add little and may delay care.
Medication Timing & Coordination
A pre-op plan aligns medications with surgical bleeding and haemodynamic risks:
- Continue chronic therapies that protect the heart (e.g., beta-blockers and statins) unless your team advises otherwise. Starting beta-blockers de novo right before surgery is generally avoided.
- Antiplatelets/anticoagulants. Management is individualized. Recent stents, stroke risk, the bleeding profile of the operation, and renal function all influence timing. Decisions on holding/continuing aspirin, P2Y12 inhibitors, warfarin, or DOACs—and whether to bridge—should follow guideline algorithms and be coordinated with surgery/anesthesia.
- Blood pressure, diabetes and fluids. Optimizing BP, glucose and volume status before the date reduces complications and supports smoother recovery
What to Expect in a 30-minute Pre-op Heart Review
- History & examination: symptoms, prior heart disease, and procedure context.
- Functional capacity check: brief DASI-style review to gauge exercise tolerance.
- Baseline tests if indicated: ECG and bloods; echo or stress testing only when results will change decisions.
- Medication plan: blood thinners, BP and diabetes medications aligned to the surgical plan.
- Written summary for the team: clear recommendations for the surgeon and anesthetist (and for you)
The Bottom Line
A pre-operative cardiology review isn’t a barrier; it’s a safety net. By clarifying risk, targeting tests, and aligning medications, we reduce delays and improve outcomes—so you can have the operation you need with greater confidence.
Have an upcoming procedure? contact Dr. Fady Turquieh for a pre-op heart review so we can tailor a plan for you and your surgical team.
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