Perioperative cardiac complications are the most widely feared medical issues for the anesthesiologist, surgeon, and medical consultant as they approach a patient with the option of surgery. To assess for the preoperative cardiac risk, hospitalists should follow a step-wise algorithm. The following module reviews the risk assessment process and enables the hospitalist to order appropriate preoperative testing.

Provide hospitalists with current assessment strategies to evaluate for perioperative cardiac risk.

This activity is designed for hospitalists. No prerequisites required.

After completing the module, the participant should be able to:

1. Tailor the perioperative evaluation based on the urgency of the procedure.
2. Determine if there are red flag issues that may necessitate delaying non-emergent surgery.
3. Identify the risk associated with different types of procedures and how and when to determine metabolic equivalents.
4. Delineate the clinical risk factors and determine when to evaluate for their presence.
5. Assess the appropriate uses for cardiac stress testing and coronary revascularization in the preoperative cardiac evaluation.

The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

Accreditation Statement: The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement: The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 2 AMA PRA Category 1 Credit(s)^™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release date: July 2008. Expiration date: July 2012

Estimated time to complete activity: 2 hours

Full Disclosure Policy Affecting CME Activities: As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of The Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following:

^*Instructor of Medicine, Johns Hopkins Hospitalists, Baltimore, Maryland.

^†Assistant Professor of Medicine and Pediatrics, Johns Hopkins Hospitalists, Director, Comprehensive General Medicine Consult Service, Editor, Johns Hopkins Consultative Medicine Essentials for Hospitalists, Baltimore, Maryland.

Conflict of Interest: Dr Siddiqui reports having no significant financial or advisory relationships with corporate organizations related to this activity; Dr Feldman reports having no significant financial or advisory relationships with corporate organizations related to this activity.

Off-Label Product Discussion: All faculty have indicated that they have not referenced unlabeled or unapproved uses of drugs or devices.

Disclaimer: The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.

Address correspondence to: Zishan Siddiqui, MD, Instructor of Medicine, Johns Hopkins Hospitalists, 600 North Wolfe Street, Park 307, Baltimore, MD 21287. E-mail: zsiddiq1@jhmi.edu.

Click here to download the references for this educational activity.

The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: an unaccredited pre-test, a study program, and a CME post-test. All 3 sections must be completed to receive CME credit.

Supported by an educational grant from Merck & Co., Inc.