Cardiac clearance for major surgery

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Submitted by Dr T on June 10, 2011 – 1:12pm

Question: 
Hi Dr T,
I am 63, in 1991 had inferior/posterior MI, with EF of 43%. Naturally, my EKG is abnormal. I am presently in need for inguinal hernia repair (under sedation, plus local anesthesia)and the surgeon requests clearance from a cardiologist for the procedure. (I have to locate one yet and feel that I am for a battery of tests).I previously had a dental surgery (implants, in 2004) with severe nausea upon awakening, however, recently I was OK after sedation during colonoscopy. What sedation would be best for me, and what other factors cardiologist should consider for his clearance? Thank you very much!

Anybody with known heart disease who needs a major operation, should be cleared cardiac-wise to make sure the procedure will be safe. This is usually done with an EKG, some blood work and a stress test:
https://www.cardiachealth.org/heart-disease-diagnosis/exercise-stress-tests
The type of anesthesia depends on the procedure, but in your case it probably doesn’t matter, whatever you, your surgeon and anesthesiologist are comfortable with. If your stress test is positive, your cardiac condition will need to be evaluated more thoroughly (like with a cardiac catherization or CTCA):
https://www.cardiachealth.org/heart-disease-diagnosis/cardiac-catheteri
https://www.cardiachealth.org/heart-disease-diagnosis/ct-angiography-fo
At that point, a decision needs to be made whether your coronary artery disease requires a procedure such as a stent or bypass surgery vs. continued medical therapy. If you haven’t had any angina since your MI and have lived a healthy lifestyle, this is unlikely!
https://www.cardiachealth.org/heart-disease-treatment/treatment-options
If you need a procedure you can evaluate your options here:
https://www.cardiachealth.org/app/
Hope this helps,
Dr T
https://www.cardiachealth.org/

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