Question

A patient is posted for elective inguinal hernia repair. He has a past history of myocardial infarction for which he underwent CABG. What is the appropriate preoperative cardiac assessment?

• A. History + clinical examination + routine labs + angiography to look for stent patency
• B. History + clinical examination + routine labs
• C. History + clinical examination + routine labs + stress test
• D. History + clinical examination + routine labs + V/Q scan

Hint:

He had bypass surgery, not a stent, so which functional test tells you how his heart copes under load?

Answer 1

The Correct Option is C

Step 1: This is an elective, intermediate-risk surgery in a patient with established coronary artery disease who has had a CABG. Preoperative evaluation aims to grade his current functional cardiac reserve.
Step 2: Every patient gets a focused history, clinical examination, and routine labs. The added step here is functional testing of the heart.
Step 3: A stress test (exercise or pharmacological) shows whether the myocardium develops ischaemia under load and gives the surgeon and anaesthetist an objective measure of cardiac function before surgery.
Why not the others: Coronary angiography to check stent patency is wrong because he had bypass grafting (CABG), not stenting/angioplasty, so there is no stent to assess. A V/Q scan evaluates pulmonary embolism, not cardiac fitness, and is not relevant here.
Ref: ACC/AHA Perioperative Cardiac Evaluation Guidelines.