Table 2

Active Cardiac Conditions for Which the Patient Should Undergo Evaluation and Treatment Before Noncardiac Surgery (Class I, Level of Evidence: B)

Unstable coronary syndromesUnstable or severe angina(CCS class III or IV)
Recent MI
Decompensated HF (NYHA functional class IV; worsening or new-onset HF)
Significant arrhythmiasHigh-grade atrioventricular block
Mobitz II atrioventricular block
Third-degree atrioventricular heart block
Symptomatic ventricular arrhythmias
Supraventricular arrhythmias (including atrial fibrillation) with uncontrolled ventricular rate (HR greater than 100 bpm at rest)
Symptomatic bradycardia
Newly recognized ventricular tachycardia
Severe valvular diseaseSevere aortic stenosis (mean pressure gradient greater than 40 mm Hg, aortic valve area less than 1.0 cm2, or symptomatic)
Symptomatic mitral stenosis (progressive dyspnea on exertion, exertional presyncope, or HF)

CCS indicates Canadian Cardiovascular Society; HF = heart failure; HR, heart rate; MI, myocardial infarction; and NYHA, New York Heart Association.

  • According to Campeau (10).

  • May include “stable” angina in patients who are unusually sedentary.

  • The American College of Cardiology National Database Library defines recent MI as greater than 7 d but less than or equal to 1 month (within 30 d).