Cardiology>>>>>Assessment for Surgery
Question 5#

You are asked to review a 76-year-old man who has been admitted to a surgical ward with bowel obstruction. A CT scan suggests that a colonic malignancy is responsible. Urgent surgery is planned to relieve the obstruction. The anaesthetist has asked for your advice since the patient reports limiting angina and is not normally able to climb two flights of stairs without becoming breathless. He currently takes aspirin, ramipril, simvastatin, and bisoprolol. Your initial assessment concludes that he is currently free from angina and is euvolaemic with no signs of cardiac failure. His resting ECG demonstrates lateral T-wave inversion.

What would be your most likely response?

a. Surgery needs to be postponed until he has had an echocardiogram
b. Surgery needs to be postponed until he has had an exercise echocardiogram
c. Surgery needs to be postponed until he has a stress echocardiogram
d. Surgery should go ahead since his life would be at risk without it
e. His cardiac status is such that an operation is high risk and should never be considered

Correct Answer is D

Comment:

Decisions regarding non-cardiac surgery should be made jointly by the surgeon, anaesthetist, and patient, with input from specialist teams. There is always a balance of benefits against risks. In this circumstance, surgery should not be postponed since the consequences of doing so might be life threatening. The results of further tests would not change this decision, but the patient should continue on his current medication.