The value to the anesthesia-surgical care team of the preoperative cardiac consultation.

A retrospective analysis of 202 consultations for preoperative cardiology evaluation was conducted. The most common problems generating the consultation were: (1) abnormal electrocardiogram, 45 patients; (2) chest pain, 36 patients; (3) history of myocardial infarction, 27 patients; (4) dysrhythmia, 25 patients; and (5) hypertension, 23 patients. The most common diagnoses by the consultants were: (1) arteriosclerotic heart disease, 46 patients; (2) angina, 20 patients; and (3) hypertension, 40 patients. Mitral valve prolapse was the most common valvular disease (18 patients). Of the consultation requests, 108 asked for an evaluation; 79 asked for a "clearance"; 9 did not specifically ask for anything; and 6 asked a highly specific question. Most consultations provided a diagnosis (96%), addressed the problem (80%), and provided logical recommendations (96%). A minority of the consultations "cleared" a patient (28%), provided for follow-up care (41%), or suggested intraoperative monitoring techniques (41%). Out of the 189 patients who eventually had surgery, 137 patients had no change in their preoperative therapy, while 52 patients had a change in preoperative therapy. There was no difference in the incidence of complications between these two groups. An important finding was that 15% of the study group (31 patients) had disease processes (hypertension and angina) that were newly diagnosed by the consultant or felt to be not adequately treated before the consultation. It is concluded that few requesting anesthesiologists and surgeons ask for clarification of a specific problem, while most responses from the cardiology consultants provided necessary information. In addition, the preoperative cardiac consultation was found to identify medical conditions requiring long-term care and follow-up.