Pre-operative Cardiac Assessment
Understand your heart risk before surgery with a private pre-operative cardiac assessment with Consultant Cardiologist Dr Salam Salloum (GMC 5209498). Available face to face in Peterborough or Corby, or by video or telephone from anywhere in the UK.
What is a pre-operative cardiac assessment?
Any operation puts extra demand on the heart, through the anaesthetic, blood loss, pain, and changes in blood pressure and fluids. Most people with a healthy heart have no problem. People with heart disease, or several heart risk factors, have a higher risk of complications around the time of surgery, such as a heart attack, an abnormal heart rhythm or heart failure.
A pre-operative cardiac assessment (sometimes called a pre-surgery heart check) is a specialist review of your heart before a planned operation. It estimates your risk, checks that any heart condition is as well treated as possible, and helps your surgeon and anaesthetist plan your care.
What decides your heart risk?
- How healthy your heart is, including any known heart disease, rhythm problem or valve problem
- How fit you are, for example whether you can climb two flights of stairs without stopping
- Other conditions such as diabetes, kidney disease or high blood pressure
- The type and urgency of the operation: cataract surgery or a minor procedure carries a low cardiac risk, while major abdominal, vascular or joint surgery carries a higher one
Who needs a heart check before surgery?
- People with known heart disease, such as coronary disease, previous heart attack, a stent or bypass, heart failure, valve disease or an irregular rhythm
- People with symptoms such as chest pain, breathlessness, palpitations, ankle swelling or fainting
- People with risk factors such as high blood pressure, diabetes, kidney disease, a strong family history or a history of stroke
- People with a pacemaker or defibrillator
- People with a newly discovered heart murmur or abnormal ECG
- People who are limited in their activity and cannot climb two flights of stairs comfortably
- People having intermediate or higher-risk surgery, such as major abdominal, vascular, orthopaedic or chest surgery
- Anyone asked by their surgeon or anaesthetist to have a cardiology review
If you are fit, have no heart symptoms and are having low-risk surgery, you usually do not need a specialist cardiac assessment. National guidance advises against routine heart tests in this situation, because they rarely change the plan.
What happens in a pre-operative cardiac assessment?
Depending on your history, the assessment may include:
- A detailed review of your symptoms, medical history, medicines and the planned operation
- An estimate of your fitness (functional capacity) and a risk score that combines your heart history, other conditions and the type of surgery
- Examination, blood pressure measurement and a 12-lead ECG
- Advice about your heart medicines, including blood thinners, around the time of surgery
Tests that may be advised
- An echocardiogram to check pumping function and the heart valves, when the result will change management
- A stress echocardiogram or other test if there is a concern about the blood supply to the heart
- Blood tests, such as a blood count, kidney function and, in selected higher-risk patients, markers of heart strain or damage (NT-proBNP and troponin)
- Heart-rhythm monitoring if you have palpitations or blackouts
Tests are arranged only when the result is likely to change your plan. Many people need only a consultation and an ECG.
Should I stop my heart medicines before surgery?
Advice about heart medicines is individual, so please do not stop any heart medicine, especially aspirin, clopidogrel, other antiplatelets or anticoagulants, unless the doctors looking after you have told you to. Stopping them without advice can cause a stroke, a blocked stent or a heart attack.
- Beta-blockers and statins are usually continued through surgery
- Blood thinners are managed according to your bleeding risk, your clotting risk and the type of surgery. A plan for when to stop and restart them should be agreed before the operation
- Some blood pressure tablets, such as ACE inhibitors, ARBs and diuretics, may be paused on the morning of surgery. Your anaesthetist will advise
- If you have had a recent stent or heart attack, the timing of planned surgery matters, so tell your surgeon and anaesthetist
Having surgery with a heart condition
- Coronary artery disease and angina: symptoms and treatment are reviewed, and tests are advised only when they will change the plan
- Heart failure: treatment is optimised before surgery, and fluid and kidney function are monitored around the operation
- Aortic stenosis and other valve disease: severe valve disease may need treatment before major surgery, or special anaesthetic planning
- Atrial fibrillation: heart rate and anticoagulation are reviewed
- High blood pressure: very high readings are brought under control first
- Pacemakers and defibrillators: the device is checked before surgery and the theatre team is told how to protect it during the operation
What happens after the assessment?
You receive a clear written letter with your cardiac risk, any recommendations to improve your heart before surgery, and advice for the team looking after you. You can share it with your surgeon, anaesthetist and GP.
Possible outcomes
- Your heart risk is acceptable and you can go ahead as planned
- Your treatment is adjusted before the operation to lower the risk
- Further tests are advised first
- Extra monitoring around the time of surgery is recommended, or a different anaesthetic approach is discussed
- In some cases, planned surgery is postponed until a heart problem has been treated
The assessment helps to inform decisions. It does not guarantee that surgery will be risk-free, and the final decision remains with you and your surgical and anaesthetic team.
When should I have a cardiac assessment before surgery?
Ideally, book as soon as you know your surgery date, so there is time for any test or treatment to be completed. If your surgery is urgent or an emergency, it should not be delayed for a cardiology assessment unless your surgical team asks for one.
If your hospital pre-assessment clinic or anaesthetist has raised a heart concern, bring their letter to your appointment.
How to book a pre-operative cardiac assessment
- Video consultation or telephone consultation: suitable for discussing your risk, reviewing results and medicines
- Face-to-face consultation in Peterborough or Corby: includes examination and an ECG
- Echocardiogram and stress echocardiogram: arranged if your risk or symptoms mean the result would change your plan
- Professional ECG reporting and nationwide cardiac monitoring: if you need your ECG reported or a heart-rhythm or blood-pressure monitor before surgery
- If you have already had heart tests, a cardiac investigations review is also available
Self-funded patients do not need a GP referral. If you plan to use private medical insurance, please check your cover and obtain any authorisation before booking. You can book a consultation online or contact the clinic.
Pre-operative cardiac assessment questions and answers
Is this the same as a pre-assessment clinic at the hospital?
No. A hospital pre-assessment is a general check. A cardiac assessment is a specialist review of your heart risk, usually requested when you have heart symptoms, heart disease or higher-risk surgery.
Will I definitely need tests?
Not always. Many people only need a consultation and ECG. Further tests are advised if they will change your plan.
Could I be told I cannot have my operation?
The aim is to make surgery safer, not to stop it. Occasionally a heart problem needs treating first, and the timing of surgery is then discussed with you and your surgical team. The final decision is yours.
Can I be seen remotely?
Yes, for the discussion. If you need an ECG or examination, a face-to-face consultation is better.
Should I stop my heart tablets before surgery?
No, not unless a doctor involved in your care has told you to. Bring a list of all your medicines, including any blood thinners, to your appointment.
What should I bring?
- Your surgeon or pre-assessment letter, if you have one
- A list of your medicines and any allergies
- Previous ECGs, echo, scan and angiogram reports, and clinic letters
Can I use private medical insurance?
Cover varies between insurers and policies, so please check before booking.
Questions to ask your surgeon, anaesthetist and cardiologist
- What is my heart risk for this operation, and can it be lowered?
- Do I need any further heart tests, and will they change the plan?
- Which of my medicines should I continue, stop or restart, and when?
- Will I need extra monitoring during or after the operation?
- Is it safe to go ahead on the planned date?
- What symptoms after the operation should I report straight away?
Pre-operative cardiac assessment key facts
- It estimates your heart risk before planned surgery and helps your surgical team plan your care.
- It is most useful if you have heart disease, heart symptoms, several risk factors or higher-risk surgery.
- Tests are arranged only when they are likely to change your plan.
- Do not stop heart medicines, especially blood thinners, unless advised by your doctors.
- Urgent or emergency surgery should not be delayed for a cardiac assessment.
This page follows the 2022 European Society of Cardiology guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery, the 2024 AHA/ACC guideline for perioperative cardiovascular management for noncardiac surgery, NICE guideline NG45 on routine preoperative tests for elective surgery (2016) and NHS patient information.
If you are due to have surgery and have heart symptoms, a known heart condition or heart risk factors, you can book a video consultation or telephone consultation to discuss your risk, or a face to face consultation in Peterborough or Corby with an ECG. Tests such as echocardiography and stress echo can be arranged if needed.
Book Your Pre-operative Cardiac Assessment
Personalised care
Your history, tests and questions are reviewed so the advice fits you.
Consultant-led care
Seen and assessed by a consultant cardiologist.
Clear
next steps
A written letter with your findings and next steps.
Advanced
diagnostics
Specialist in echo, stress echo, cardiac CT, MRI and heart failure.
Medically reviewed by Dr Salam Salloum, Consultant Cardiologist. Last reviewed: . This page is for general information and does not replace personal medical advice.