Juraj Dúbrava
The cardiovascular complications on noncardiac surgery (NCS) respond for the majority of perioperative morbidity and mortality. The actual viewpoint on perioperative cardiovascular management for NCS follows mainly from the guideline update of the American College of Cardiology and the American Heart Association published in 2002. The fundamental principles of the management are: Preoperative diagnostic and therapeutic interventions are only rarely necessary simply to lower the risk of NCS. Principally they are indicated unless such interventions are needed irrespective of the surgery. The diagnostics before NCS is warranted only if it affects cardiologic therapy, anesthesia or surgery. Betablockers significantly reduce perioperative ischemia, acute myocardial infarction and the mortality mainly in high risk cardiac patients. Coronary revascularization before NCS in order only „to get through the surgery“ is rarely justified in very high cardiac risk. It is indicated only irrespective of the preoperative context. This article reviews an algorithm of cardiovascular risk stratification depending on: 1. clinical predictors, 2. functional capacity, 3. surgery-specific risk.