History & Examination
- Full anaesthetic history
- Specific areas of focus:
- Associated symptoms
- Last echo and it’s findings
- Cardiology interventions and follow-up
- Examination of cardiovascular and respiratory system
Investigations
- Echo – strongly desirable, consider delaying non-essential surgery until performed:
- Severity of stenosis
- LV function
- Bloods:
- FBC to exclude anaemia
- Coagulation studies – particularly if on warfarin
- U&E and renal function – may be disturbed if on diuretics
- BNP
- ECG:
- LVH / LV strain
- Arrhythmias
- Chest Xray
Risk Assessment & Optimisation
- Referral to cardiologist – assistance with decisions regarding:
- Appropriateness of surgery
- Need for pre-operative intervention:
- Aortic valve replacement
- TAVI
- Balloon valvuloplasty
- Lee index or ‘revised cardiac risk’ index tool
- Use information to consent appropriately with risks involved
Premedication
- Consider using anxiolytics to prevent tachycardia