Question of the Week

For June 1, 2021

A 63-year-old woman with hypertension, hyperlipidemia, and gastroesophageal reflux disease presents for preoperative evaluation before surgical repair of a torn right rotator cuff.

She develops exertional angina after approximately 30 minutes of brisk walking that resolves with rest; these symptoms have been stable for 2 years. She underwent an exercise single-photon-emission CT nuclear stress test 11 months ago, which revealed a small area of mild reversibility in the inferior wall. At that time, her left ventricular ejection fraction was 61%. She was managed medically, and her symptoms have been stable since. She denies dyspnea, leg swelling, or orthopnea.

Her current medications are aspirin 81 mg daily, atorvastatin 40 mg at bedtime, pantoprazole 40 mg daily, and metoprolol succinate 100 mg daily.

Her blood pressure is 123/72 mm Hg, and her heart rhythm is regular at a rate of 66 beats per minute. She has no murmurs or gallops on cardiac examination. The rest of her physical examination is unremarkable.

In addition to continuing the beta-blocker and statin, which one of the following approaches is most appropriate for this patient's preoperative management?

Perform cardiac catheterization and percutaneous coronary intervention for any significant lesions
Perform an echocardiogram
Perform a nuclear stress test
Perform an exercise treadmill test without imaging
No further evaluation is required; proceed to surgery

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