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Management of Patients With Heart Disease for Noncardiac Surgery

John H. Tinker, MD; Carl R. Noback, MD; Ronald E. Vlietstra, MD; Robert L. Frye, MD
JAMA. 1981;246(12):1348-1350. doi:10.1001/jama.1981.03320120050031.
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PHYSICIANS are frequently consulted about the advisability and perioperative management of noncardiac surgery in patients with heart disease. The risks in patients with coronary artery disease have been extensively studied, whereas other types of heart disease, perhaps because of their more uniformly progressive nature, have not proved as amenable to specific risk analysis. Clinical judgment remains central to the assessment of the risk-benefit ratio of any proposed procedure. We intend to present briefly considerations of risk, preoperative pharmacologic management, and a discussion of basic principles of operative and postoperative care.

Risk of Noncardiac Surgery in Patients With Coronary Artery Disease 

Prior Myocardial Infarction.—  Several retrospective studies have shown that patients with a prior myocardial infarction (MI) have about a 6% incidence of new infarction occurring within seven days of anesthesia and surgery, unless the prior MI was recent.1-3 Operations performed within three months of an MI are associated with


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