[Preoperative cardiac risk assessment and diagnosis. The view of the cardiologist].

Perioperative morbidity and mortality in noncardiac surgery are mainly due to cardiovascular complications. Therefore, perioperative risk assessment is crucial to avoid these adverse events. In patients above the age of 40 years, the ECG is a basic investigation, often providing hints for cardiovascular diseases. Stress testing and, in special cases, stress echocardiography or scintigraphy (the latter only in those patients, in which exercise is impossible) can detect significant coronary artery disease. The vascularization reduced the perioperative risk in particular in those patients with unstable angina or severe coronary artery disease. However, prophylactic revascularization the stable patient does not improve overall outcome, because the risk of the revascularizing procedure must be added to the risk of noncardiac surgery. Other diagnostic procedures like echocardiography, chest roentgenogram, routine scintigraphy, halter ECG or halter blood pressure measurement do not add information to the perioperative risk assessment, although these techniques might be very relevant in evaluating other coexisting diseases (heart failure; valve lesions, in particular aortic stenoses etc.) and can be useful to improve medical treatment preoperatively (e.g. normalization of blood pressure).