Table III. Preoperative cardiac evaluation for the patient undergoing aneurysm repair
1. Is there an active cardiac condition?
  • Unstable coronary syndrome
    • Unstable or severe angina
    • Recent MI (<1 month)
  • Decompensated CHF
  • Significant arrhythmias
  • Severe valvular disease

Presence cancels or delays aneurysm repair until conditions are treated. Implement medical management and consider coronary angiography.
2. Does the patient have good functional capacity without symptoms?
  • MET ≥4 (Table IV)

Clinical risk factors

  • Mild angina pectoris
  • Prior MI
  • Compensated or prior CHF
  • Diabetes mellitus
  • Renal insufficiency

May proceed with aneurysm repair. In patients with known cardiovascular disease or at least one clinical risk factor, beta blockade is appropriate.
3. Is functional capacity poor or unknown?
  • MET <4 (Table IV)

Clinical risk factors

  • Mild angina pectoris
  • Prior MI
  • Compensated or prior CHF
  • Diabetes mellitus
  • Renal insufficiency

In patients with three or more clinical risk factors, preoperative noninvasive testing is appropriate if it will change management.

CHF, Congestive heart failure; MET, metabolic equivalent; MI, myocardial infarction.
From Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, et al. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg 2009;50(Suppl):S2-49; originally adapted from Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: executive summary. Circulation 2007;116:1971-96.