Cardiac clearance is a medical assessment or workup that a surgeon and anesthesia provider (anesthesiologist or certified registered nurse anesthetist, or CRNA) should consider before an elective, non-cardiac surgery.
The idea behind cardiac clearance is to assess a patient’s risk of a cardiovascular event occurring during the surgery and what interventions and plans can be made to manage them. If a serious heart condition is uncovered, the elective surgery will be delayed or canceled so the life-threatening cardiac issues can be addressed.
The importance of a thorough pre-surgical history and physical exam
From my experience as a Houston, Texas medical malpractice attorney, I’ve come to believe that some surgeons and anesthesiologists don’t put as much thought into cardiac risk or cardiac clearance as they should.
I’ve been thinking about this a lot lately because of a medical malpractice wrongful death case that I’m working on.
A patient in his 30s was scheduled for a short elective orthopedic surgery that would require general anesthesia and a regional interscalene block. The surgeon and anesthesia providers didn’t see a need to send him for cardiac clearance because of his young age and seemingly-low risk. His only apparent risk factors were obesity and high blood pressure (hypertension). He was taking two medications to help control his high blood pressure.
Based on what the doctors wrote down in the patient’s medical record, the medical experts that Painter Law Firm hired to review the case said that it was reasonable not to order a cardiac clearance because he appeared to be low risk.
What we don’t know is whether the surgeon and anesthesia providers took a thorough history from the patient or just “went through the motions.” Taking a history is when a doctor asks the patient questions about their current and past medical conditions, signs and symptoms, surgical history, and medications.
Some surgeons refer their patients to a primary care or internal medicine physician for a physical exam and thorough history. It’s then left to the primary care doctor or internist to decide if further workup by a cardiologist is warranted.
I’ve spoken with some cardiologists who recommend that every patient who’s expected to have general anesthesia for an elective (non-emergency surgery) should have, at a minimum, a 12-lead EKG. They said that some doctors may think it’s unnecessary or there may be some insurance issues, but this inexpensive test is the best first-line way to help identify a life-threatening cardiac problem. If a family member or I am ever in this position, you can be 100% certain that we’ll be having a 12-lead EKG. Perhaps you should consider asking for one, too.
If you’re referred for this type of pre-surgical workup or clearance, it’s important to be thorough in filling out paperwork and answering questions from your doctors and surgeons about your personal and family medical history, medications you’re taking, any chest pain or angina, any breathing problems, and whether you’ve ever had a bad experience with anesthesia. In short, share everything that you can think of because it may be important to the provider in assessing your risk.
Before the surgery, your surgeon will do a physical exam and take a patient history of his or her own. On the day of surgery, an anesthesiologist and/or CRNA will do a pre-anesthesia assessment. Even though these providers may seem rushed, it’s important to share all of the same information with these providers. Your safety is the most important thing!
