What's needed to protect the heart during such operations?

It's too bad that ticker trouble doesn't guarantee good health elsewhere in the body. Most people with heart disease have other ailments, including some that require surgery.

What's needed to protect the heart during such operations? The December issue of the Harvard Heart Letter offers nine questions to help you and your doctor determine if you need cardiac testing or treatment before undergoing surgery.

New guidelines from the American College of Cardiology and American Heart Association take some of the stress—and stress testing—out of surgery. They limit the use of pre-surgery stress testing, especially before low-risk procedures such as colonoscopy, cataract removal, and most outpatient surgeries. For higher-risk operations, like surgery on the aorta or other blood vessels, prostate surgery, or bone or joint surgery, whether you need testing and preventive care depends on the state of your heart. People with an active heart condition such as unstable heart failure, a significant heart rhythm problem, or severe valve disease need pre-surgery cardiac evaluation, and possibly treatment, more than those with stable, well-controlled heart disease.

The Harvard Heart Letter 's questions include these:

• How urgent is the operation? In an emergency, there's no time to second-guess cardiac risk. If the surgery can be delayed, cardiac considerations become more important.
• What's your functional status? Can you climb stairs without needing to stop because of chest pain or breathlessness? The more you're able to do, the less you need a presurgical cardiac evaluation.
• Do you have cardiac risk factors? Angina, diabetes, kidney disease, controlled heart failure, or a prior stroke increase the chances of heart trouble during surgery. If you don't have any of these risk factors, you probably don't need special precautions before surgery.

Also in this issue:

• Genetic testing before starting warfarin
• Isolated systolic hypertension
• Pacemaker infections
• Off-pump bypass surgery in women
• Heart deaths and flu

The Harvard Heart Letter is available from Harvard Health Publications, the publishing division of Harvard Medical School, for $28 per year. Subscribe at http://www.health.harvard.edu/heart or by calling 1-877-649-9457 (toll-free).

http://www.health.harvard.edu