Heart disease

Cardiac disease may be exacerbated by many of the physiologic changes accompanying surgery,including fluctuations in heart rate, blood pressure, blood volume, oxygenation, pH, and coagulability. Increased circulating cathecolamines or sympathetic nervous system activity may precipitate arrhytmias as well as increase heart rate and blood pressure. Anesthesia and medications such as vagolytics and muscle relaxants have direct effects on myocardial contractility, automaticity, and conduction. The greatest risk occurs in the 72 hours following operation, when fluid volume shifts, fluctuations in heart rate and blood pressure, and medication changes are greatest and the ability to control them is compromised.
Cardiac conditions masquerading as surgical illnesses
1. Myocardial infarction or angina
2. Right heart failure
3. Ascites or pericardial disease
4. Dysphagia due to left atrial enlargement or disease of the aorta.
5. Back and abdominal pain due to aortic dissection.
The ECG should reveal evolving or recent infarction, and the physical examination and chest x-ray should demonstrated heart failure or sign of pericardial disease. Echocardiography will confirm valvular disease and pericardial disease and may reveal a source of emboli.
Goldman index:
- s2 gallop 11
- MI in previous 6 months 10
- more than five VPCs/min. 7
- nonsinus rhythm 7
- age >70 years 5
- emergency operation 4
- intrathoracic, intraperitoneal, aortic surgery 3
- significant aortic stenosis 3
- poor general medical condition 3

Mortality rate: score is 0-5, 1%. 6-12, 7%. 13-25, 13%. >26, 78%.