PRE OPERATIVE CARDIAC RISK

ASSESSMENT IN NON CARDIAC SURGERY

dr. Mohammad Arief Kurniawan

Pembimbing : dr. Widya Istanto N Sp.An,,KAKV,KAR

Resiko pembedahan
terhadap kejadian
kardiovaskuler
Banyak pasien yang menjalani operasi noncardiac besar
beresiko untuk acara kardiovaskular perioperatif

Risiko terkait dengan resiko spesifik pasien dan resiko

operasi

Di antara pasien yang tidak dipilih di atas usia 40 perioperatif MI di 1,4 persen dan kematian jantung di
1,0 persen

Angka kematian pasien dengan perioperatif MI substansial ,

mulai dari 30 % sampai 50 %

Factors to be Considered
When Assessing Cardiac
Risk
Patient-Related Factors
Age
Chronic diseases (e.g., coronary artery disease, diabetes mellitus,
hypertension)
Functional status
Medical therapy
Implantable devices
Previous surgeries
Surgery-Related Factors
Type of surgery (e.g., vascular, endoscopic, abdominal)
Urgency of the operation (e.g., emergent, urgent, elective)
Duration of the operation, possibility of blood loss and fluid shifts
Test-Related Factors
Sensitivity and specificity of a test
Effect on management

INITIAL PREOPERATIVE
EVALUATION
anamnesa

Pemeriksa
an fisik

Keluhan dan gejala

seperti angina, dyspnoe,
syncope, palpitasi
Riw sakit jantung,
hipertensi, DM, CKD,
CVD, PAD

Tanda vital (TD, HR, RR,

SpO2)
Status kapasitas
fungsional

Electrocardiography

ECG
direkomendasikan
sebelum prosedur
resiko menengah
dengan minimal
satu faktor klinis
yanng
diidentifikasi oleh
RCRI
ECG tidak
diperlukan pada
pasien dengan
prosedur resiko
rendah

Preoperative Cardiac
Risk Index

Goldman Risk Index

Preoperative third heart sound or jugular venous distention
indicating active heart failure

11

Myocardial infarction in the past 6 months

10

5 Premature ventricular complexes/min before surgery

Rhythm other than sinus

Age 70 years

Emergency surgery

Significant aortic stenosis

Intraperitoneal, intrathoracic, or aortic surgery

Markers of poor general medical condition (e.g., renal

dysfunction, liver disease, lung disease, electrolyte imbalance)

Patients in the lowest risk quartile (0 to 5 points) had less than a 1% risk of
postoperative major cardiac complications. In the two middle quartiles with 6 to
25 points, the major cardiac event risk was 9%, and 22% of the patients in the
highest risk group (26 points) had a major perioperative cardiac event.

Eagles Cardiac Risk

Index

Q waves on the electrocardiogram (ECG) History of angina

pectoris
History of ventricular ectopy requiring treatment (most
specific for predicting events)
Diabetes mellitus requiring therapy other than diet
Age older than 70 years
Thallium redistribution (most sensitive for predicting
events)
Ischemic electrocardiographic changes during or after
infusionof risk factors: 3.1% risk of perioperative
dipyridamole
No clinical predictors
ischemic cardiac complications
Thallium redistribution in addition to one or two clinical
predictors: 29.6% risk of perioperative complications
Three clinical predictors: 50% risk of perioperative cardiac
complications

Detskys Cardiac Risk

Index