The Management of Cardiac Patients in Relation to Surgery

T HE internist frequently is called upon by his surgical colleagues for an opinion concerning the risk of anesthesia and of a surgical procedure in a patient who has organic heart disease. A request of this kind carries with it a number of implied questions, among the most important of which are: 1. Does the cardiac abnormality increase the risk of the contemplated procedure? 2. Will the anesthesia and surgical operation increase the demands on the heart beyond the limits of the cardiac reserve and therefore precipitate congestive heart failure? 3. Does the cardiac condition require treatment before operation? 4. Is the prognosis of the heart condition so grave that surgery should be limited to an emergency or palliative procedure? 5. Is the heart disease of such a nature that it carries with it the liability of sudden death (luring anesthesia and surgical operation? 6. What bearing does the state of the heart have on the choice of the anesthetic agent ? 7. What, if ally, cardiovascular complications are to be anticipated during the operation and postoperative period? The information necessary to answver these questions usually, can be obtained from the clinical history and physical examination without resorting to more elaborate forms of investigation. It still is quite commonly believed that during anesthesia and surgical operations the heart