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The Patient with Heart Disease: Preoperative Evaluation and Preparation

We are concerned about this patient for several reasons. Because of his increased intravascular volume, the management of his fluid and electrolyte replacement becomes very complicated. He is a candidate for thromboembolic phenomena such as pulmonary emboli. With decreased ventilation, there is increased likelihood for hypoxia and hypercarbia as well as respiratcry infections and pneumonia. He has impaired liver and kidney function, which can change the effects of drugs. In addition, the various stresses to which a surgical patient is exposed can push him into acute heart failure. Failure may be precipitated by pain, fear, or apprehension, or with the induction of general anesthesia. He may be inadvertently given too much fluid for his cardiac status.