From the Guidelines
The cardiac risk for this 54-year-old female patient undergoing meniscal tear repair is low. Based on her cardiac evaluation, which showed no significant coronary artery disease on CTA, normal left ventricular function with an ejection fraction of 59%, and a nuclear stress test with only a small defect likely due to artifact, she does not have evidence of significant cardiac disease that would increase her perioperative risk 1. Meniscal repair is considered a low-risk surgical procedure from a cardiac perspective, typically associated with less than 1% risk of major adverse cardiac events. Despite her risk factors of obesity, hyperlipidemia, and chronic kidney disease, the comprehensive cardiac workup has effectively ruled out significant coronary disease.
According to the ACC/AHA 2007 guidelines, patients undergoing low-risk surgery, such as meniscal tear repair, with no clinical risk factors or with 1 or 2 clinical risk factors, can proceed with the planned surgery without further evaluation 1. However, considering her clinical risk factors, including chronic kidney disease, it is reasonable to consider perioperative heart rate control with beta blockade, as suggested by the 2012 statement from the American Heart Association and the American College of Cardiology Foundation 1.
The patient's regular medications for hyperlipidemia and other conditions should be continued as directed by her physicians, with possible adjustment of certain medications on the day of surgery. The patient should be monitored with standard perioperative care, including vital signs and possibly ECG monitoring during the procedure, but special cardiac precautions beyond routine care are not necessary given her favorable cardiac evaluation results. Perioperative beta-blockade may be considered to reduce cardiovascular risk, but it should be titrated carefully to avoid hypotension and other adverse effects 1.
From the Research
Cardiac Risk Assessment
The patient's cardiac risk for the meniscal tear repair surgery can be assessed based on their medical history and current cardiac evaluation.
- The patient has a history of obesity, hyperlipidemia, and chronic kidney disease (CKD), which are all risk factors for cardiovascular disease.
- The patient underwent a nuclear stress test that showed a small defect with mild intensity in the anterior wall, likely secondary to artifact.
- The patient also underwent a CTA that showed no significant coronary artery disease.
- The echo showed an EF of 59%, which is slightly below the normal range.
Relevant Studies
There are no studies provided that directly address the cardiac risk for meniscal tear repair surgery in patients with a history of obesity, hyperlipidemia, and CKD.
- However, studies 2 and 3 discuss the epidemiology of meniscus injury and the association between obesity and meniscal tears, which may be relevant to the patient's overall health status.
- Study 4 discusses the outcomes of arthroscopic all-inside repair versus observation in older patients with meniscus root tears, but does not address cardiac risk specifically.
Cardiac Risk Factors
The patient's cardiac risk factors include:
- Obesity
- Hyperlipidemia
- CKD
- Slightly reduced EF (59%)
- History of intermittent chest pain, although the nuclear stress test and CTA did not show significant coronary artery disease. The patient's cardiac risk for the surgery should be evaluated by a cardiologist or anesthesiologist to determine the best course of action.