Assessing Preoperative Cardiac Risk

In Episode 17 of Med School Question of the Week for USMLE, Alisa Khomutova, MedSchoolCoach expert tutor, answers this medical school question: A 67-year-old man is scheduled to undergo an open sigmoidectomy for complicated diverticulitis in 2 weeks. He had a myocardial infarction at the age of 57 years. He has a history of unstable angina, hyperlipidemia, hypertension and severe osteoarthritis of the spine that limits his daily mobility. He quit smoking 10 years ago, and does not consume alcohol. Current medications include aspirin, metoprolol, lisinopril, rosuvastatin and ibuprofen as needed. His temperature in 36.4°C (97.5°F), pulse is 88/min, and blood pressure is 139/86 mm Hg. Physical examination shows no abnormalities. A 12-lead ECG shows Q waves and inverted T waves in leads II, III, and a VF. His B-type natriuretic protein is wnl). Which of the following is the most appropriate next step in management to assess this patient’s perioperative cardiac risk?

• 24-hour ECG ambulatory monitoring
• Resting echocardiography
• Exercise echocardiography
• Radionucleotide myocardial perfusion imaging
• Treadmill stress test
• No further testing