Does the patient have an acute cardiac condition which precludes surgery, namely myocardial ischemia current or recent, unstable cardiac arrhythmia, or decompensated heart failure, for which the patient should undergo evaluation and treatment before surgery?
Non-emergency surgery Acute cardiac condition(s) unsuitable for surgery is/are present
Evaluate & treat cardiac condition(s) according to guideline directed medical therapy. Or consider non-invasive alternatives to surgery, and/or palliative care.
If acutely unsuitable cardiac conditions are found and optimized per guidelines, then re-consider suitability for the operating room, with attention to timing of surgery after a cardiac event or intervention as best as possible, see Timing section of app.
Acute coronary syndrome refers to any group of clinical symptoms compatible with acute myocardial ischemia and includes unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI).
Each of these conditions warrants guideline directed evaluation and management, including appropriate delay before reconsidering surgical intervention. See discussion in Timing section of app.
These conditions should be evaluated and treated while consulting with relevant multidisciplinary team members and the patient regarding risks, benefits, and alternatives to cardiac condition treatment and surgical alternatives.
This question also represents the first "off-ramp" in the decisions tree process. The ACC algorithm has always had this step, but it previously identified only ACS (coronary ischemia syndromes) as an issue which could derail progress towards surgical intervention. Additional off-ramps appear in the next step, Estimation of Perioperative Risk.
