Heart Tests Before Surgery

When Are They Not Helpful

If youre scheduled for non-cardiac surgery, a test that takes pictures of your heart can sometimes help to identify risky undiagnosed cardiac problems that may require a delay in your operation. But if your surgery isnt related to the heart and you dont have heart-related symptoms or risk factors, the test may not be helpful.

Pre-surgical imaging tests are NOT always necessary.

A pre-surgery imaging test such as an exercise or chemical stress test with imagingusing sound waves or a small dose of a radioactive substance or even a cardiac CT scancan show whether youre at risk of experiencing serious heart problems, such as a heart attack or heart failure, during or soon after surgery. Abnormal results may lead to postponing surgery until the problem is treated, choosing a less invasive procedure, or getting special care at the time of your operation.

However, these tests arent useful for most people undergoing low risk procedures such as eye surgery or breast biopsy. Thats because the risk of heart complications from such operations is so low that its hard to do anything differently to lower it further. In fact, even major surgery is safe for most healthy people who feel well and are moderately active without symptoms. All they usually need is a medical history and physical exam.

Drawing Blood Before Surgery

Unless you have a special type of IV inserted prior to surgery, you can expect a member of the hospital staff to draw blood from your vein using a small needle.

This process is usually simple, and you should notice little more than a quick pinch as the needle is inserted. The person drawing blood may use a tourniquet in order to find your veins more easily. It’s removed once the needle is inserted.

If you have a sensitivity to latex or adhesives, you may want to request that no bandage or tape be used on the site, as the bleeding usually stops quickly.

If this is the case, however, be sure that your healthcare provider is aware of this issue, as you may need a bandage on your surgical site after your procedure.

Blood Tests Before Surgery

Blood tests are frequently drawn before surgery. This is done for a number of reasonsto examine your general state of health, to determine if any signs of infection are present, or to determine how a specific organ is functioning.

The blood tests listed here are among the most common and may be performed after your surgery is complete in addition to any pre-surgery screening that is done.

Having blood drawn does not mean there is a problem it is often done to spot an issue before it becomes serious. Many blood tests will be repeated after surgery to determine if any changes have happened to your health status.

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Are There Alternatives To Standard Open

Thanks to medical advancements, many procedures that once required opening the chest can now take place using minimally invasive heart surgery or with small incisions. The surgeon sometimes still needs to cut through part of the breastbone .

Depending on your situation, your surgeon may be able to use these methods:

• Catheter-based: Your surgeon threads a catheter to the heart. The surgeon then inserts surgical instruments, balloons, or stents through the catheter to perform a procedure. Catheter-based procedures include transcatheter aortic valve replacement and coronary angioplasty and stenting.
• Video-assisted thoracic surgery : Your surgeon performs VATS by inserting a tiny video camera and surgical instruments into several small chest incisions. Your surgeon may use VATS to place a pacemaker, repair heart valves or treat an arrhythmia.
• Robotically-assisted: Certain patients with valvular heart disease, cardiac tumors, atrial fibrillation and septal defects may be candidates for this minimally invasive approach.

Electrolyte And Creatinine Testing

The electrolyte panel and creatinine measurement have been obtained routinely as part of the preoperative evaluation. No trials have documented changes in outcomes among patients who had electrolyte testing before surgical procedures.8 Three guidelines made recommendations on preoperative electrolyte testing,2,3,8 based on expert opinion and low-level evidence.1 One guideline advocates obtaining serum blood urea nitrogen and creatinine measurements in patients older than 40 years.8 However, the consensus is that findings from the history and physical examination, rather than age alone, should guide decisions about electrolyte and renal function testing. Compelling historical findings and certain medications should drive the decision to perform preoperative electrolyte and creatinine testing.2,3,8

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What Is Recovery Like After Open

Recovery time varies depending on the surgery type, complications and your overall health before surgery. It can take 6 to 12 weeks to recover from an open-heart procedure.

Your surgeon will let you know when you can return to work and other activities. Typically, you shouldnt drive or lift anything heavy for the first six weeks.

Some people need to take blood thinners after heart surgery to prevent blood clots. Your healthcare provider may also recommend cardiac rehabilitation. This medically supervised program can help you regain strength and stamina and improve overall heart health.

What Are The Risks

The tests can pose risks!

Preoperative imaging tests are usually very safe and can be done with little or no radiation. But if youre unlikely to have a heart problem, they may produce false-positive results that could prompt anxiety, additional risky testing, and a delay of your surgery. For instance, they might be followed up with coronary angiography , a test that uses dye and X-rays to look at your heart vessels. While the risk from any one test may be acceptable, risks are cumulative and can cause harm down the road so its best to avoid unnecessary radiation exposure or invasive procedures.

When are the tests needed before surgery?

An imaging test may be ordered even for low-risk surgery if you have a severe heart condition or youre experiencing symptoms that could be heart-related, such as chest pain, breathing difficulty, or a loss of stamina. They may also be considered prior to intermediate-risk surgery or high-risk surgery in people who have risk factorsincluding diabetes, kidney disease, or a history of coronary artery disease, heart failure or stroke, and who have poor exercise tolerance making it hard to assess heart-related symptoms or cant walk a short distance or climb stairs without experiencing heart-related symptoms.

Make sure to talk to your family health care provider and surgeon regarding your individual needs.

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Doctors Can Predict Who Is At Greater Risk Of Heart Attacks And Other Negative Vascular Events After Surgery

Date:

McMaster University

Summary:

The VISION study looked at whether levels of a cardiac blood test, NT-proBNP, measured before surgery can predict cardiac and vascular complications. Higher levels of NT-proBNP, which can be caused by various anomalies in the cardiac muscle, such as stress, inflammation or overstretch, can help identify which patients are at greatest risk of cardiac complications after surgery. The study included 10,402 patients aged 45 years or older having non-cardiac surgery with overnight stay from 16 hospitals in nine countries.

A common cardiac blood test done before surgery can predict who will experience adverse outcomes after most types of surgery, says an international study led by Hamilton researchers.

Globally, of the 200 million adults who undergo major surgery, 18 percent will experience serious cardiac and vascular complications including death within 30 days following their intervention, such as hip and knee replacements, bowel resections and abdominal aortic aneurysm repair.

“Any type of surgery has the potential to cause damage to heart tissue, through blood clot formation, long periods of inflammation, or bleeding,” said study lead, Dr. PJ Deveraux, professor of medicine, cardiologist at Hamilton Health Sciences and scientific lead for perioperative research at McMaster University and HHS’ Population Health Research Institute .

Study data was published today in Annals of Internal Medicine.

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Tests Done Before Surgery

Many surgeons order routine lab tests before you are admitted to the hospital or before certain outpatient procedures. The tests help find possible problems that might complicate surgery if not found and treated early. Some of the most common tests done before surgery include:

• Chest X-rays. X-rays can help diagnose causes of shortness of breath, chest pain, cough, and certain fevers. They can also help diagnose abnormal heart, breathing, and lung sounds.

• Electrocardiogram . This test records the electrical activity of the heart. It shows abnormal rhythms , finds heart muscle damage, and helps find the cause of chest pain, fluttering heartbeats , and heart murmurs.

• Urinalysis. This test can help diagnose kidney and bladder infections, and diabetes. Certain types of urinalysis can also find illegal drugs in the body.

• White blood count. This test can help diagnose certain fevers and infections. It can also find out if a person is using medicines that affect white blood counts.

You may also need one or more of the following blood tests before surgery:

• Glucose. This test measures your blood sugar levels.

• Potassium. This test measures the amount of potassium, sodium, and other electrolytes in your blood. These chemicals help regulate heart rhythms and other body functions.

• Complete blood count . This test checks for a low number of red blood cells and infection.

• Coagulation studies . These tests find out how well your blood clots.

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Cardiac Fitness Before Surgery

In this context, knowing the patients in this category is imperative. India is a developing nation where a battery of tests adds to the economic burden. Clinicians should only ask for relevant tests, which are mandatory for that particular case and, at the same time, not skip a specific test that is critical for that patient. The operating surgeon and the anaesthesiologist should thoroughly assess the patient regarding their current physiological and pathological status, which includes a detailed clinical history , thorough examination of different systems, medication history, and previous history of any procedure or operation on any system and the heart.

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The suggested tests should be in accordance with the complexity of surgery as categorised by the National Institute of Clinical Excellence as minor, intermediate, major, or complex. They should also be according to the type of surgery such as elective, semi-elective, urgent, or emergent surgery.

Dr. Mohanty said, “Our classical teaching emphasises the principle of 30, 40, & 50, which means getting an X-ray chest done at the age of 30 years and above, ECG at 40, and Echocardiography at 50. These are standard routine tests. However, if a patient is a neonate or a child having by-birth heart defects, then chest X-ray, ECG, and Echocardiography are mandatory even at this age.”

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When Should You Have The Tests Before Heart Surgery

• Breathing tests can be useful if you have a lung disease such as asthma or chronic obstructive pulmonary disease . They also make sense if you have symptoms such as shortness of breath.
• A carotid ultrasound makes sense if you have a history of stroke or mini-strokes .

This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

08/2013

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How Do I Manage Post

A cardiac anesthesiologist is also a pain management specialist for conditions related to surgery. Your anesthesiologist will talk to you about your options for managing post-operative pain. Before your surgery, the anesthesiologist may ask about your pain tolerance to help gauge how best to manage your post-operative pain, guiding decisions such as the proper narcotics dosage, the feasibility of nonnarcotic pain medication options, and the need for nerve blocks.

Although most heart surgeries are major surgeries, they are typically not a source of long-term pain. Even in the short term, the pain may be less severe than with operations on other areas of the body. Opioids are used when necessary, but there are many other pain management options, including:

• Lidocaine infusion

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What Are The Types Of Open

There are two ways to perform open-heart surgery:

• On-pump: A heart-lung bypass machine connects to the heart and temporarily takes over for the heart and lungs. It circulates blood through the body while moving blood away from the heart. The surgeon then operates on a heart that isnt beating and doesnt have blood flow. After surgery, the surgeon disconnects the device and the heart starts to work again.
• Off-pump:Off-pump bypass surgery takes place on a heart that continues to beat on its own. This approach only works for coronary artery bypass grafting surgery . Your surgeon may call this beating-heart surgery.

Visits With Other Doctors

Your surgeon will want to make sure that other health conditions you may have will not cause problems during your surgery. So you may need to visit:

• A heart doctor , if you have a history of heart problems or if you smoke heavily, have high blood pressure or diabetes, or are out of shape and cannot walk up a flight of stairs.
• A diabetes doctor , if you have diabetes or if your blood sugar test in your pre-op visit was high.
• A sleep doctor, if you have obstructive sleep apnea, which causes choking or a stop in breathing when you are asleep.
• A doctor who treats blood disorders , if you’ve had blood clots in the past or you have close relatives who have had blood clots.
• Your primary care provider for a review of your health problems, exam, and any tests needed before surgery.

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Heart Imaging Tests Can Pose Risks

These tests are usually very safe. But if your risk of having a heart problem is low, the tests can create a false alarm instead of finding a serious problem. That can cause anxiety. It can also lead to more tests or an unneeded delay of surgery.

For example, you might have a follow-up test to view the blood vessels in your heart. This test is called coronary angiography. During this test, a very thin tube is inserted into the heart through a vein. Dye is injected, and X-rays are taken. The risks are low, but exposure to X-rays adds up over your lifetime. Its best to avoid X-rays whenever you can.

What Does Open

You may need open-heart surgery if you have one of these heart conditions:

• Heart valve replacement or repair to treat heart valve disease.
• Left ventricular assist device or total artificial heart placement to treat heart failure.

Sometimes, surgeons place pacemakers or implantable cardioverter defibrillators during open-heart surgery while performing other procedures. Ablation procedures to treat arrhythmias may also occur in the same procedure.

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What Is A Pre

In the surgeons opinion, a pre-operative diagnosis for bypass surgery is the diagnosis that will be confirmed during surgery. A pre-operative diagnosis for bypass surgery is determined through a series of tests before the bypass operation, otherwise known as a pre-operative assessment. Your pre-operative diagnosis for bypass surgery will govern the type of bypass youll need. This could be either:

The type of bypass youll need will depend on the number of arteries blocked. More blockages can mean that surgery could take longer or be more complex however, a pre-operative diagnosis for bypass surgery will determine this. Tests before your bypass operation will confirm the type of bypass you need. Pre-op testing for bypass surgery will also assess how well your arteries are coping in their current condition. The tests before your bypass operation can also determine if this procedure needs to be adjusted.

What Is The Recovery Time

Recovery time depends on the type of surgery you have, but for most types of heart surgery you are likely to spend a day or more in the hospitalâs intensive care unit. Then you will be moved to another part of the hospital for several days until you go home.

The National Heart, Lung, and Blood Institute notes that the length of your recovery time at home will depend on the type of surgery you had, your overall health before the surgery, and whether you experienced any complications from surgery. For example, full recovery from a traditional coronary artery bypass may take six to 12 weeks or more.

Anesthesiologists are the most highly skilled medical experts in anesthesia care, pain management, and critical care medicine. They have the education and training that, in some circumstances, can mean the difference between life and death.

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