Coronary artery disease (angina and fitness for anaesthesia)

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