2007 Car​diac Algorithm - Step 5

With poor functional capacity, symptoms with activity, or unknown functional capacity, further evaluation is indicated by clinical risk factors for cardiac disease:

  • ischemic heart disease
  • renal insufficiency
  • cerebrovascular disease
  • diabetes
  • prior or compensated CHF


Total risk factors:

Zero risk factors

Non-emergency surgery
No active cardiac conditions
Mod-to-high risk surgery
Poor/unknown functional capacity
No clinical risk factors

Proceed to Operating Room

1-2 risk factors

Non-emergency surgery
No active cardiac conditions
Mod-to-high risk surgery
Poor/unknown functional capacity
1-2 clinical risk factors

Clinician has two options:

1) Proceed to O.R. with beta-blockade for heart rate control
-or-
2) Consider non-invasive coronary evaluation, i.e. stress test, if it will change management

3-5 risk factors