The impact of cardiovascular disease is substantial in patients presenting for anesthesia and surgery.... Perioperative cardiac morbidity is high, and increased perioperative risk persists in those with recent myocardial infarction, congestive heart failure, symptomatic valvular disease, and several forms of congenital heart disease. perioperative care thus remains a challenge. The cornerstone of perioperative care is the peroperative assessment of patients for anesthesia and surgery. Only by identifying at-risk patients and the severity of their diseases can we judiciously assign optimal preoperative treatment, anesthetic management techniques, and intraoperative monitoring strategies, and anticipate potential intraoperative therapeutic requirements and the need for postoperative intensive care.Preoperative assessment of the patient with cardiovascular disease can be difficult for at least two reasons. First, the at-risk patient can be complex, presenting with a specrtum of symptoms and varying degrees of ventricular dysfunction. Second, we are in an age of cost containment, when patients present on the morning of surgery, leaving little time for evaluation. Therefore, preoperative assessment must be efficient, requiring a thorough knowledge of cardiovascular disease states, the available preoperative cardiovascular performance tests and the data they provide, and the potential perioperative risk factors.The first 3 chapters of this monograph discuss preoperative assessment strategies for patients with ischemic heart disease, valvular heart disease, and congenital heart disease. Because of the close association between cardiovascular disease and pulmonary disease, we also present the preoperative considerations for patients with pulmonary disease in Chapter 4. Finally, in Chapter 5, we review current preoperative cardiovascular medications, highlighting newer developments and controversial regimens. ... --Dennis T. Mangano, PhD, MD
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