Perioperative cardiac risk: Pathophysiology, assessment and management

Ramachandra R. Sista, Kavita V. Ernst, Euan A. Ashley

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


Cardiac complications are the leading cause of perioperative morbidity and mortality following noncardiac surgery. The annual cost of perioperative cardiovascular events exceeds US$20 billion. A strategic preoperative evaluation holds the potential to reduce perioperative cardiac events and healthcare costs; however, our current understanding of the pathophysiological basis of postoperative acute coronary syndromes is limited. Although significant advances continue to facilitate early and reliable noninvasive, detection of high-risk coronary anatomy, the most appropriate interventions remain unclear. Pharmacotherapy, revascularization, safer anesthesia and early detection of perioperative heart failure may all reduce perioperative morbidity and mortality, although the evidence base is incomplete and controversial. A close working relationship between the primary care physician, cardiologist, surgeon and anesthesiologist will facilitate rational, tailored and optimized management decisions that constitute our best opportunity to reduce perioperative cardiovascular risk.

Original languageEnglish (US)
Pages (from-to)731-743
Number of pages13
JournalExpert Review of Cardiovascular Therapy
Issue number5
StatePublished - Sep 2006


  • Catecholamines
  • Coronary plaque
  • Dobutamine stress echo
  • Non-ST elevation myocardial infarction
  • Perioperative
  • Pulmonary artery catheterization
  • ST elevation myocardial infarction
  • β-blockers

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine


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