Perioperative Medicine

Let’s talk perioperative medicine! Which patients should get a pre-operative ECG?

As we learned this week in AHD, perioperative medicine is incredibly variable. Our expert Reza explains:

The 2014 ACC/AHA guideline regarding this issue uses vague language. Here is what it says:

Preoperative resting 12-lead ECG is reasonable for patients with known coronary heart disease, significant arrhythmia, peripheral arterial disease, cerebrovascular disease, or other significant structural heart disease, except for those undergoing low-risk surgery.​

​Preoperative resting 12-lead ECG may be considered for asymptomatic patients without known coronary heart disease, except for those undergoing low-risk surgery.​

Routine preoperative resting 12-lead ECG is not useful for asymptomatic patients undergoing low-risk surgical procedures.​

What does this mean practically?

First of all, if a patient is going for minor surgery such as dermatological procedure or cataract surgery, probably don't need to worry about getting an ECG. For patients who are at elevated risk for major adverse cardiac event (elevated risk = > 1%), we should probably have a recent ECG (within 1-3 months) in the chart prior to proceeding with surgery. ​

Reza Ghoorkhanian, MD