Cardiac algorithm

[canavarim]

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My question is that while u r going down the algorithm, then u are faced let's say with a patient who is morbidly obese , or has BKA .. then u can't evaluate the functional capacity ..
do u assume he is asymptomatic , or just the opposite and go for testing ...

 

[2ndyear]

I think this is a great topic. We've all seen lots of these patients as pre-ops. Here's one thing that I have found helpful:
http://www.acc.org/qualityandscience/clinical/guidelines/perio/update/table5a.htm
Take out the functional capacity part and you get anyone with intermediate clinical predictors going for high risk surgery to get tested.
Also:
http://www.acc.org/qualityandscience/clinical/guidelines/perio/update/table2.htm
4 mets being heavy work around the house, golf, etc. Not just stairs. My standard query is "can you walk up stairs without shortness of breath or chest pain". Not uncommon to hear "I live on the first floor". It's also possible to be quite active in a wheelchair.

This is from an editorial that came out by one of the contributors to the study:
"If functional capacity cannot be adequately assessed by a careful history, an exercise ECG may be useful for the assessment of functional capacity, which helps with further risk stratification."