Preoperative ECG Indications — FRCA Final MCQ

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EasyPreoperative AssessmentPreoperative ECG IndicationsFRCA Final

A 55-year-old man undergoing elective surgery has his operation cancelled when the anaesthetist discovers an undiagnosed heart murmur with features of significant aortic stenosis. According to NICE NG45, which pre-operative test should have identified this?

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Correct answer: D — 12-lead ECG

NICE NG45 recommends a resting 12-lead ECG for all patients with cardiovascular disease, renal disease, diabetes, or ASA ≥3 undergoing intermediate or major surgery. An ECG may show left ventricular hypertrophy (LVH) suggesting significant AS, though it is not diagnostic. Echocardiography is not a routine pre-operative test but should be requested when AS is suspected (new murmur, exertional symptoms, ECG showing LVH). The NICE pathway is: clinical history → auscultation → ECG → echocardiography if indicated.

Reference: NICE – 2016 – NG45 Routine preoperative tests; NICE – 2021 – NG185 Heart valve disease