An 80-year-old man comes to your office for evaluation of a scheduled cholecystectomy by laparoscopy. He has a history of arterial hypertension under treatment for 10 years. He denies heart or pulmonary disease. She has no chest pain. She has an active life and goes daily to the gym where she alternates swimming and walking on the treadmill for at least one hour. Usual treatment: nebivolol 5 mg every 24 hours and hydrochlorothiazide 12.5 mg daily. Physical examination: weight 73 kgs; height 179 cm; blood pressure 138/80 mmHg; heart rate 60 beats/minute. No murmurs are auscultated Which of the following is the most appropriate preoperative approach?
This is a completely gratuitous question, from a healthier gentleman than me who is going to undergo low-risk surgery on a scheduled basis. The answer is obviously 4. Had there been a fifth option it would have been that nothing needs to be done, which might have generated some doubt in the student, but since the question does not exist it is a piece of candy. Although there are many protocols on preoperative procedures, almost as many as there are hospitals, the question makes it easy by putting a very old patient, 80 years old. The age range from which it is considered mandatory to request an ECG varies between 45, 50, 60 or even some say 70 years. For example: > 50 years: always, except if a previous ECG is available < 50 years: only if there is known or suspected heart disease (CVRF), severe DM, hyperthyroidism or severe COPD.
Perform a stress test.
Perform echocardiography
Perform a thallium and dipyridamole scan.
Perform electrocardiogram.
Although there are many protocols on preoperative procedures, almost as many as there are hospitals, the question makes it easy by putting a very old patient, 80 years old. The age range from which it is considered mandatory to request an ECG varies between 45, 50, 60 or even some say 70 years.