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Preoperative cardiac evaluation — ABIM Board MCQ

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ModerateGeneral Internal MedicinePreoperative cardiac evaluationABIM Board

A 66-year-old with stable coronary disease is scheduled for elective knee replacement. He climbs two flights of stairs without chest pain or dyspnea, has no unstable cardiac condition and is receiving guideline-directed therapy. What preoperative cardiac testing is indicated?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Proceed in the absence of additional cardiac testing

The best answer is “Proceed in the absence of additional cardiac testing”. Adequate functional capacity without unstable symptoms means additional ischemia testing is unlikely to change management and should not be performed routinely. Age alone is not an indication. Coronary angiography follows usual clinical indications, while biomarkers or rhythm monitoring are used selectively rather than as universal clearance tests.

Reference: 2024 AHA/ACC Perioperative Cardiovascular Management Guideline: https://professional.heart.org/en/science-news/2024-guideline-for-perioperative-cardiovascular-management-for-noncardiac-surgery