CLINICIAN GUIDE · PERIOPERATIVE CARDIAC ASSESSMENT · SECTION 1 OF 3

Understanding perioperative risk

Identify active disease and estimate procedure-specific cardiac risk.

Assess risk and optimize care

The goal is to estimate cardiovascular risk and identify actions that improve the perioperative plan. No evaluation can guarantee a complication-free procedure. Start with the exact operation, urgency, anesthesia, and expected physiologic stress.

Emergency surgery generally proceeds with coordinated risk mitigation. An elective timeline allows investigation of active disease.

^[1]^[2]

Look for active cardiac problems

Acute coronary syndrome or new concerning ischemic symptoms.
Decompensated HF or important new dyspnea.
Unstable or uncontrolled significant arrhythmia.
Severe symptomatic valve disease or another major risk modifier.

These findings call for evaluation and team discussion before elective surgery. In an unstable patient, activate acute care rather than simply completing a clearance form.

^[1]

Combine procedure risk with patient risk

Use a validated model such as RCRI or an appropriate ACS NSQIP calculator. Explain what outcome and time window it estimates. Risk tools support judgment; they do not capture every disease-specific hazard.

Document functional capacity with concrete activities or a structured tool such as DASI. Ask whether limitations are cardiac, pulmonary, orthopedic, or due to frailty.

^[1]^[3]

Clinical references

Adult clinician education · References reviewed October 11, 2026.