Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 154: A 58-Year-Old Going for Surgery
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Jul 10, 2025 Dive into the case of a 58-year-old woman getting ready for robotic cholecystectomy. Explore the critical preoperative assessments focused on her cardiovascular and pulmonary health. Learn about the importance of electrocardiograms and risk calculators for evaluating surgical readiness. Discover how individualized evaluations and functional capacity measurements play pivotal roles in planning her procedure. This discussion highlights the intricate process of ensuring safety in elective surgeries.
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Preoperative ECG Recommended
- Preoperative evaluation for a healthy 58-year-old woman having elective cholecystectomy should include a 12-lead ECG.
- No further cardiac testing is needed if the ECG is normal and risk factors are absent.
Using Cardiac Risk Index
- The Revised Cardiac Risk Index helps predict cardiac risk using six clinical factors.
- Our patient had none, indicating a very low risk of major cardiac events at surgery.
Assess Functional Capacity
- Patients with three or more cardiac risk factors should have further cardiac evaluation and assessment of functional capacity.
- Good exercise tolerance (≥4 METs) usually obviates the need for additional cardiac testing before elective surgery.
