Preoperative assessment of the patient with cardiovascular disease.

The morbidity and mortality of anaesthesia and surgery are increased by cardiac diseases. It is essential, therefore, to recognize the presence of cardiovascular diseases and to assess their severity in order to prevent serious complication during anaesthesia and the period after operation. Relatively silent cardiac or vascular diseases are often first diagnosed during the preoperative visit (Kyei-Mensah and Thornton, 1974; Frost, 1976). Where the diagnosis has already been made it is important to evaluate the severity of heart disease, to determine whether or not medical treatment could further improve cardiac function (Howat, 1971; Friedlander, 1973) and to consider the pathophysiology of the disease. The optimal anaesthetic management and the decision on invasive monitoring rest on the correct diagnosis of the disease and of its repercussions on the circulation. Detailed medical history and careful clinical examination, supplemented by electrocardiogram and chest x-ray, form the basis of evaluation before operation and may have to be complemented by echocardiography, cardiac catheterization and angiography.