From the Guidelines
An EKG should be performed for an orthographic surgery pre-op physical only if the patient has specific risk factors, such as known coronary heart disease, arrhythmias, peripheral arterial disease, cerebrovascular disease, or other significant structural heart disease, as stated in the 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline 1. For low-risk patients under 65 years without cardiac symptoms or significant cardiovascular risk factors, an EKG is generally not required, according to the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery 1. However, for patients who are older than 65, have known heart disease, cardiac symptoms (chest pain, palpitations, shortness of breath), diabetes, hypertension, or other cardiovascular risk factors, an EKG should be included in the pre-operative assessment, as recommended by the 2014 ACC/AHA guideline 1. The purpose of obtaining a pre-operative EKG is to identify any underlying cardiac abnormalities that might increase surgical risk, such as arrhythmias, conduction disorders, or evidence of ischemia or prior heart attack, which is supported by the 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline 1. Some key points to consider when deciding whether to perform an EKG include:
- Patient age and risk factors for coronary heart disease
- Presence of known coronary heart disease, arrhythmias, peripheral arterial disease, cerebrovascular disease, or other significant structural heart disease
- Type and risk level of the surgical procedure
- Presence of cardiac symptoms such as chest pain, palpitations, or shortness of breath
- Comparison with previous electrocardiographic tracings to identify any changes or abnormalities, as suggested by the 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline 1. Ultimately, the decision to perform an EKG should be based on individual patient assessment rather than applying a blanket rule for all orthopedic surgery candidates, as stated in the 2014 ACC/AHA guideline 1.
From the Research
Preoperative Evaluation for Orthographic Surgery
- The preoperative evaluation for orthographic surgery involves assessing the patient's overall health and identifying potential risks 2.
- This evaluation is crucial in patients with multiple comorbidities, as they may require special consideration and management during surgery.
Role of EKG in Preoperative Evaluation
- There is no direct evidence in the provided studies to suggest that an EKG should be performed for an orthographic surgery pre-op physical.
- However, the studies discuss the importance of beta blockers in treating arrhythmias 3, 4, 5, 6, which may be relevant in patients with cardiac conditions undergoing surgery.
Considerations for Patients with Cardiac Conditions
- Patients with cardiac conditions, such as arrhythmias, may require special consideration and management during surgery 3, 4, 5, 6.
- The use of beta blockers as anti-arrhythmic agents may be important in these patients, and an EKG may be necessary to assess their cardiac function and guide treatment 3, 4, 5, 6.