ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery)

[...]of these searches, more than 400 relevant new articles were identified. Preoperative clinical evaluation The initial history, physical examination, and electrocardiogram (ECG) assessment should focus on identification of potentially serious cardiac disorders, including coronary artery disease (CAD) [e.g., prior myocardial infarction (MI) and angina pectoris], heart failure (HF), symptomatic arrhythmias, presence of pacemaker or implantable cardioverter defibrillator (ICD), or a history of orthostatic intolerance (1). Major Unstable coronary syndromes * Acute or recent myocardial infarction* with evidence of important ischemic risk by clinical symptoms or noninvasive study *Unstable or severe[dagger] angina (Canadian class III or IV)[double dagger] Decompensated heart failure Significant arrhythmias *High-grade atrioventricular block * Symptomatic ventricular arrhythmias in the presence of underlying heart disease * Supraventricular arrhythmias with uncontrolled ventricular rate Severe valvular disease Intermediate Mild angina pectoris (Canadian class I or II) Previous myocardial infarction by history or pathological Q waves Compensated or prior heart failure Diabetes mellitus (particularly insulin-dependent) Renal insufficiency Minor Advanced age Abnormal ECG (left ventricular hypertrophy, left bundle-branch block, ST-T abnormalities) Rhythm other than sinus (e.g., atrial fibrillation) Low functional capacity (e.g., inability to climb one flight of stairs with a bag of groceries) History of stroke Uncontrolled systemic hypertension Table 1 Clinical Predictors of Increased Perioperative Cardiovascular Risk (Myocardial Infarction, Heart Failure, Death) ECG indicates electrocardiogram.