coronary heart disease (angina and fitness for anaesthesia)

Last reviewed 01/2018

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