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Coronary artery disease (angina and fitness for anaesthesia)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The patient found angina at rest or with minimal exertion at the preoperative assessment is not a candidate for elective general anaesthesia. Functional cardiac reserve is likely to be less than that required for the stresses of a major operation. The operation should be cancelled and during the same admission:

  • the cause of the angina should be investigated
  • new drug treatment should be started or existing treatment modified
  • more interventional treatment should be considered:
    • angiography with angioplasty
    • CABG

A history of exercise-induced angina is not an absolute contraindication to general anaesthesia, but an elective operation should be delayed for an assessment of functional reserve:

  • from the history, distance walked before onset
  • exercise tolerance tests, e.g. Bruce protocol on treadmill
  • MUGA scan: qualitative assessment of hypokinesis or quantitative measure of ejection fraction

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