Cardiac Pre-Assessment

What information is relevant to the 'pre-med' visit ? And what information will actually help you plan your case and affect your management ? The plan is not to replicate the full clerking etc but to guide you to the essentials for your work.

Remembering the 'pre-med' visit is a crucial time for assessment and learning for you and the patient. It forms the basis of your planning with the consultant. It also is a great reassurance to the patient and family who will likely never have heard of our department.

Cardiac Pre-assessment

The Basics !

  • Age
  • Baseline HR, BP, Saturations on ____ O2, Hx of AF.
  • General anaesthetic and airways assessment
  • Specific cardiac history
  • Chest pain history
  • SOB
  • Orthopnoea
  • Ankle swelling
  • Exercise tolerance on the flat and on an incline (usually ask how far they can walk on the flat without getting SOB/CP and how may flights of stairs can they manage)
  • Smoker/Ex-smoker

All patients will likely have had:

  • An ECHO - record the results particularly LV function, valvular abnormalities and EF
  • Angio results
  • Pulmonary function tests
  • Carotid Doppler results
  • ECG
  • CXR / CT
  • Bloods- check they have been G+S and that no antibodies present - If they are present please discuss with blood bank that blood is available.
  • Record pre-op drugs and allergies


Patients can have all their medication but it is wise to avoid ACEi and anti-platelets on day of surgery. If clopidogrel has been continued pre-op, please discuss with the cardiothoracic team that platelets are available post-op.

Inform the patient that:

  • They will have 2 drips and an arterial line inserted awake under local anaesthetic.
  • They will then be gently drifted off to sleep and have an ETT inserted which will remain post-op when they are transferred to CICU asleep.
  • They will be warmed up, their pain controlled and they will slowly be woken up with the ETT in-situ. Once the nursing staff are happy with their breathing and they are fully awake the ETT will be taken out. They may well have a sore throat afterwards.
  • Whilst they are asleep they will have a line in the neck (CVP) and if they have renal impairment it is likely they will have a vascath post-induction.
  • Warn them of a risk of bruising, bleeding, small risk of nerve damage and pneumothorax.
  • Explain they will already have chest drains in that will rectify the issue should they get a pneumothorax.

Address and answer their questions and concerns

Consider a pre-med ( and have look at the consultant preference sheet )