1. 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

2. METs

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