2007 ACC/AHA Peri-operative guidelines- Anesthesia’s recommendations Caveat #1: if patient has history of CHF (regardless of METs)  needs TTE within 1 year; or if there has been a change in symptoms since last TTE, get new TTE Caveat #2: If the patient has any murmur heard on clinical exam  TTE (to r/o AS) TTE, EKG For all <4 METs, Anesthesia wants ALL of these patients to have a TTE regardless of clinical risk factors. Even for >4 METs, but with 3+ clinical risk factors, Anesthesia wants those patients to have a TTE as well. Stress test NO Stress test

METs

Clinical risk factors History of ischemic heart disease History of compensated or prior HF History of cerebrovascular disease Diabetes mellitus Renal insufficiency