Preoperative Cardiac Evaluation Note (Noncardiac Surgery/Procedure)

Date/Time: [Date and time of note]
Author/Service: [Name, credentials, and service]
Referring Clinician: [Name and service]
Consult Type: [preoperative risk stratification / device management / optimization / postoperative surveillance / other: specify]

Reason for Consult

[Clinical question and context] (State whether this is risk stratification only, optimization prior to elective surgery, time-sensitive decision-making, or postoperative surveillance planning.)

Planned Procedure

• Procedure: [Procedure name and brief description]
• Surgical timing category: [Emergency / Urgent / Time-sensitive / Elective]
• Expected physiologic stress: [Anticipated blood loss, fluid shifts, other physiologic stressors / not yet determined]
• Planned anesthesia: [general / regional / neuraxial / monitored anesthesia care / local / not yet determined]

Executive Summary

• Key cardiac risks: [1–3 primary cardiovascular concerns]
• Functional capacity: [DASI score with interpretation / METs estimate with specific activities / functional capacity unknown] (State whether assessment is structured vs estimated and whether limitations are cardiac vs noncardiac.)
• Risk estimate: [Validated tool used (e.g., RCRI, NSQIP) and numeric estimate] — [low risk (<1% MACE) / elevated risk (≥1% MACE)]
• Recommendation: [Proceed without further cardiac testing / Defer elective surgery pending specified optimization or testing / Proceed given urgency with monitoring and mitigation plan]
• Monitoring plan: [Recommended postoperative disposition] and [troponin surveillance: indicated with timing / not indicated]

HPI — Perioperative Cardiovascular Focus

[Narrative summary beginning with planned procedure and timing] (Address current cardiovascular symptoms including chest pain, dyspnea, orthopnea, edema, syncope, palpitations; recent clinical trajectory including stability vs decompensation, recent hospitalizations, recent ACS or HF exacerbation; current hemodynamic status including blood pressure control and volume status. For ACHD patients, include baseline oxygen saturation and cyanosis status. Document source limitations if information is unavailable.)

Functional Capacity

[DASI score and interpretation using ≤34 threshold for poor capacity / METs estimate with specific activities patient can or cannot perform / functional capacity unknown with reason stated] (Specify whether assessment is structured vs estimated, and whether limitation is cardiac vs noncardiac. Do not infer from age or appearance.)

Pertinent Cardiovascular History

(Include only applicable domains. Omit sections without relevant history.)

Coronary Disease

• [Known CAD status and prior MI dates]
• [Revascularization history: PCI with stent type and dates, CABG with dates]
• [Current angina status]
• [Most recent stress test or coronary imaging with date and key findings]

Heart Failure

• [HF type: HFrEF / HFmrEF / HFpEF], NYHA class [I / II / III / IV]
• [Most recent LVEF with date]
• [Recent decompensation or hospitalizations]

Valvular Disease

• [Valve lesion(s) and severity]
• [Last echocardiogram date]
• [High-risk lesions such as severe AS or MS, if present]
• [Prior valve interventions with dates]

Arrhythmias

• [AF/flutter history, VT, bradyarrhythmias, prior ablations]
• [Current rhythm and rate-control strategy]
• [Anticoagulation indication and status]

CIED (if present)

• [Device type, manufacturer/model, implant date]
• [Last interrogation date]
• [Pacing dependence status and known magnet response]

ACHD (if applicable)

• [Lesion diagnosis using standard terminology]
• [Prior surgeries/interventions and residual lesions]
• [Baseline SpO₂ and cyanosis status]
• [Pulmonary hypertension or ventricular dysfunction if present]
• [Anatomic complexity and physiologic stage if available]

Pulmonary Hypertension (if applicable)

• [Etiology group and severity markers]
• [Targeted therapy list]
• [Most recent PASP and RV function]

Relevant Noncardiac Comorbidities

(Include only when these affect perioperative cardiovascular or medication planning.)

• [CKD with most recent creatinine and estimated creatinine clearance]
• [Diabetes and perioperative medication implications]
• [OSA and CPAP use]
• [Prior stroke/TIA]
• [Significant lung disease]
• [Anemia or bleeding disorders]

Current Medications and Perioperative Plan

(List relevant cardiac medications with explicit perioperative instructions for each.)

• Beta blockers: [Current regimen and plan] (Continue if already on; if newly indicated, start >7 days pre-op when feasible; avoid initiation on day of surgery unless immediate indication.)
• Statins: [Current regimen and plan] (Continue; initiate perioperatively only if patient meets long-term ASCVD criteria.)
• RAAS inhibitors: [Agent, indication (HTN vs HFrEF), and plan] (Consider holding 24h pre-op for HTN indication; continue for HFrEF.)
• SGLT2 inhibitors: [Agent and target last dose date] (Stop 3–4 days pre-op.)
• Antiplatelets: [Aspirin and/or P2Y12 agent with indication] (For post-PCI: document PCI date, indication, stent type, and whether minimum DAPT duration is met. State plan for continuation vs interruption with timing.)
• Anticoagulants: [Agent and indication] (Provide planned last dose timing based on renal function and bleeding risk; bridging decision with rationale—generally avoid routine bridging; restart timing after hemostasis; specify coordinating team.)
• Other cardiac medications: [Diuretics, antiarrhythmics, nitrates, PAH therapies, etc., with perioperative plan]

Medication reconciliation status: [Complete / Incomplete—sources reviewed and gaps noted]

Physical Exam

(Include only if performed. If exam deferred, state reason rather than inserting normal findings.)

• Vitals: [BP, HR, SpO₂, weight if relevant]
• Volume status: [JVP, edema, rales/crackles]
• Cardiac exam: [Rate/rhythm, murmurs, rubs, gallops]
• Peripheral findings: [Cyanosis/clubbing if ACHD, pulses]
• Device pocket (if CIED): [Inspection/palpation findings]

Data Reviewed

(Specify date, source, and key findings for each. Indicate whether from in-system testing, outside records, or patient report. Omit items without data unless crucial—then note "Not available—requested".)

• ECG: [Date/source] — [Rhythm, conduction, QTc, ischemic changes]
• Echocardiogram: [Date/source] — [LVEF, RV function, valve gradients/areas, PA pressures]
• Stress test/coronary imaging: [Date/source] — [Ischemia findings, high-risk anatomy]
• Labs: [Date/source] — [Creatinine/CrCl, hemoglobin, BNP or NT-proBNP (abnormal: BNP >92, NT-proBNP ≥300), baseline troponin if obtained]
• Device interrogation (if CIED): [Date/source] — [Pacing dependence, battery status, therapies/events]

Perioperative Risk Stratification

• Surgical risk: [Low / Elevated] — [Basis: guideline category or NSQIP classification]
• Patient risk: [Validated tool], [Key inputs], [Numeric output] — [Low (<1% MACE) / Elevated (≥1% MACE)]
• Risk modifiers present: [Recent PCI requiring DAPT / severe valvular disease / severe PH or RV dysfunction / poor functional capacity / elevated biomarkers / ACHD with intermediate or high-risk physiology / pacemaker dependence with expected EMI / none]
• Active cardiac conditions screen: [ACS or unstable angina / decompensated HF / uncontrolled significant arrhythmia / severe symptomatic valvular disease / none present] (If any present, document that elective surgery should be deferred unless emergent.)

Assessment and Recommendations

Global Recommendation

[Proceed without further testing / Defer elective surgery pending specified optimization or testing / Proceed given urgency with monitoring and mitigation plan]

Postoperative disposition: [PACU only / floor / telemetry / stepdown / ICU]

Cardiovascular Problems

(Problem-oriented format. For each applicable cardiovascular issue, provide brief assessment and specific plan with timing and responsible party.)

[Cardiovascular problem]: [Assessment integrating relevant subjective, objective, and risk data]

• Plan: [Specific actions, medications with doses if applicable, coordination needs, follow-up timing]

Preoperative Testing

[No additional cardiac testing indicated preoperatively / Testing indicated: specify test, clinical rationale, and what management decision it will change]

CIED Management (if EMI anticipated)

• Device: [Type and pacing dependence status]
• EMI risk: [Surgery location relative to generator, EMI likelihood]
• Plan: [Reprogram / Magnet], intraoperative backup pacing/defibrillation availability
• Responsible team: [CIED team / vendor / EP]; post-op reprogramming restoration required

ACHD-Specific Considerations (if applicable)

• ACHD specialist involvement: [Status of coordination]
• Lesion-specific considerations: [Air filters for right-to-left shunt, abnormal vascular anatomy, endocarditis prophylaxis indication, arrhythmia vigilance, invasive monitoring needs]

Pulmonary Hypertension Management (if applicable)

• [Continue targeted PAH therapies with perioperative delivery plan]
• [PH center involvement status]
• [Monitoring recommendations for severe PH]

Arrhythmia Management

• Baseline rhythm: [Status and trigger mitigation strategy for pain, anemia, electrolytes]
• Plan for new-onset perioperative AF: [Rate/rhythm strategy, anticoagulation considerations, outpatient follow-up]

Postoperative Monitoring

• Disposition: [PACU only / floor / telemetry / stepdown / ICU]
• Hemodynamic monitoring: [Invasive / Noninvasive]
• Troponin surveillance: [Not indicated / Indicated: timing (e.g., 24 and 48 hours post-op) and escalation thresholds]

Communication and Follow-Up

• Contacts: [Surgeon / Anesthesia / EP / ACHD specialist / PH team] — [Summary of discussion and agreements]
• Pending items: [Records requested, tests ordered, consults placed]
• Pre-op follow-up: [Visits or checks needed prior to surgery if optimization or testing pending]
• Post-op follow-up: [Plan for MINS surveillance, arrhythmia follow-up, device reprogramming verification, clinic follow-up timing]

Risk estimates are probabilistic and do not guarantee outcomes. Anesthesia and surgical teams determine operative and anesthetic feasibility; this consultation provides cardiovascular risk assessment and recommendations.