Preoperative cardiac evaluation.

A thorough history and a complete physical examination will detect most cardiac problems that can affect perioperative management or outcome. Further diagnostic tests, including an electrocardiogram, a chest radiograph and more sophisticated studies, should be performed if indicated by the history and physical examination. Congestive heart failure and a myocardial infarction within the six months before surgery are the most important risk factors for postoperative cardiac events, but almost all cardiovascular diseases have some impact on perioperative management and risk stratification. Regional anesthesia is no safer than general anesthesia, except under a few circumstances.