Before many surgical procedures, pre-surgery screenings are necessary to make sure a patient can handle the stress that surgery can put on the body. Depending on the surgery (and the patient’s unique health history), cardiac screenings may also be included as part of the preoperative testing. Here, Shalini Modi, M.D., a cardiologist at Henry Ford Health, breaks down the importance of these screenings and how they play a part in your surgery outcomes.
“There are very real physiological changes that the body undergoes during surgery that can cause cardiac stress,” says Dr. Modi. “The point of screening before surgery is to assess your general risk for having the surgery.”
There are a few factors that influence what is involved in your pre-surgery screening process including:
- Health of the patient (their age, any pre-existing health concerns, heart issues, etc.)
- The urgency of the procedure (Is the surgery emergent, urgent or can it be put off until after screenings?)
- Surgical risk for the patient (What type of surgery is this, what are the chances of cardiac complication?)
Not all surgeries require any preoperative screenings. Procedures like routine colonoscopies or cataract surgery are often considered low-risk and may not need screenings unless patients have any new cardiac symptoms.
“I always tell my patients that we just want to make sure they don’t have an acute coronary event during or post-surgery,” says Dr. Modi. “Patients that have heart complications during or after a procedure are at an increased risk of mortality 30 days following the surgery.”
When you meet with a surgeon to begin planning for an operation, be sure to connect with your primary care provider right away. The sooner you can be seen, the better your chances of having your surgery happen as planned. Your provider can help decide if you need additional screenings before the procedure.
“For example, sometimes we have to make decisions regarding medications you might be on to manage existing health conditions like diabetes or high blood pressure,” says Dr. Modi. “We need to assess the risk of taking you off that medicine for some time or making sure you are still taking it throughout your postoperative recovery. Your primary care provider or cardiologist can assess what medications you are taking and make recommendations.”
Pre-Surgery Screenings For Patients With Cardiac Concerns
Patients with known heart issues will be referred to their cardiologist as part of the preoperative screening process.
Possible heart issues may include:
- Coronary artery disease (having a recent heart attack or a stent put in)
- Recent open-heart surgery
- History of a recent stroke
- Congenital heart failure
- Severe valvular heart disease
- Arrhythmias (heart rhythm disorders)
Depending on your health status, different tests might be used to evaluate your heart health. This may include:
- Electrocardiogram (EKG): Evaluates how the heart organ functions regularly to assess how it might handle the stress of surgery.
- Echocardiogram: Imaging used to evaluate the heart muscles, especially for older patients or those with symptoms or risk factors of heart complications.
- Cardiac lab work: Checks for clotting disorders that could impact a surgical operation.
- Cardiac stress test: Measures the functional capacity of your heart to help experts understand if a patient’s heart is able to handle the outcomes of surgery.
If something is flagged during your cardiac screenings or if stress test abnormality is detected, cardiologists use a specialized risk calculator to categorize these results by low or high-risk cases. From there, they make an educated decision to determine whether surgery is a good idea for your heart. Since the goal for preoperative clearance is to get patients through surgery without complication – your doctor won’t want to delay this decision if they believe your heart can handle it.
“The biggest element that we are trying to assess from the cardiac screenings is an individual’s functional capacity,” says Dr. Modi. “We are trying to understand – are you active, do you work out, can you walk up and down stairs, or take brisk walks with ease? If yes, chances are, you will recovery from surgery well. The more active you are before surgery, the better your post-surgery outcome are.”
While your need for surgery may not always be so clear or come at a time when you expect it, Dr. Modi encourages patients to be very aware of how their lifestyle choices may impact surgical outcomes. Taking initiative to manage any existing heart conditions, meeting with your primary care physician regularly to discuss your overall health and staying physical active can make all the difference.
Reviewed by Dr. Shalini Modi, a cardiologist who sees patients at Henry Ford West Bloomfield Hospital.
