3. General Guidelines: The 7 Rules

Rules 6 - 7:

6. Preoperative testing should be used as needed. If a patient is identified with new onset angina, unstable angina, a change in the anginal pattern, or congestive failure the further risk stratification is appropriate. If the patient is stable with known CAD, PVD, or two risk factors for CAD, they should be placed on a beta blocker.

7. Care should be taken with patients who are in congestive heart failure (CHF), aortic stenosis, or renal failure. All patients who have CHF should be evaluated by cardiology for the initiation of beta blocker therapy. Beta blocker therapy has been shown in multiple studies to reduce the risk of death from CHF. Many patients with CHF are profoundly improved by beta blockade. Patients with aortic stenosis should be evaluated by cardiology and beta blockade initiated with cardiology supervision. Patients with renal failure should be treated with agents but special attention is needed.