Who Needs a Pre-op Echo?

Co-morbidities:  Only unstable conditions should delay going to the  OR (Active ACS, Unstable Arrhythmia, Decompensated CHF and Known Moderate/Severe Aortic or Mitral stenosis [a-d]) below:

  1. Active Acute Coronary Syndrome (ischemic EKG changes or elevated troponin)

i.Cardiology consult and OR delay until optimized

  1. Unstable Arrhythmia (hypotension or significantly uncontrolled)

i.Cardiology consult and OR delay until optimized

  1. Decompensated CHF with new symptoms:  see “Patients requiring an echo”

i.New symptoms or severe decompensation needs an echo before OR

  1. Known Mod/Severe AS or Mod/Severe MS with no echo in the past 12 months
  1. Pulmonary Compromise

               a. COPD/Asthma- continue inhaled bronchodilators/steroids. If acute, serious exacerbation--consider delaying surgery 24-48 hours with steroid treatment

               b. Acute bronchitis/PNA: Assess for sepsis/SIRS/bactermia and treat as necessary

    6. Anemia

                                i.Transfusion trigger is Hgb < 8

  1. Diabetes/Elevated blood sugar

i.Goal  blood sugar 100-180 (too low increases falls, too high impedes repair)

Patients Requiring an Echo

  1. A recent Echo is defined as in the last 12 months
  2. Only patients with the following conditions require a new echo

i.CHF with new symptoms/signs of decompensation

ii.Mod/severe aortic stenosis or mitral stenosis

     3. With new severe symptoms or new oxygen requirement

     4. If no echo in last 12 months

     5. Coordinate with cardiology to have echo done within 12 hours of admission (before 11 am next day)