angina (fitness for anaesthesia)
Last reviewed 01/2018
The patient found angina at rest or with minimal exertion at the preoperative assessment is not a candidate for elective general anaesthesia. Functional cardiac reserve is likely to be less than that required for the stresses of a major operation. The operation should be cancelled and during the same admission:
- the cause of the angina should be investigated
- new drug treatment should be started or existing treatment modified
- more interventional treatment should be considered:
- angiography with angioplasty
- CABG
A history of exercise-induced angina is not an absolute contraindication to general anaesthesia, but an elective operation should be delayed for an assessment of functional reserve:
- from the history, distance walked before onset
- exercise tolerance tests, e.g. Bruce protocol on treadmill
- MUGA scan: qualitative assessment of hypokinesis or quantitative measure of ejection fraction