Question

70 yo M is seen for a pre-operative medical evaluation before laminectomy for spinal stenosis. Swims for 30 minutes every other day. ECG performed 2 years ago demonstrated a left anterior fascicular block, several PAC, and sinus rhythm. Most appropriate pre-operative cardiac testing for this patient?

Answer 1

Pre-operative cardiac testing for a patient with an active lifestyle and a history of left anterior fascicular block could involve non-invasive stress testing with thallium-201, pending further clinical risk assessment.

Step-by-step explanation:

The most appropriate pre-operative cardiac testing for a 70-year-old male with a history of left anterior fascicular block and premature atrial contractions (PACs), who is active and swims regularly, would be dictated by current clinical guidelines which generally recommend non-invasive stress testing for patients with at least two clinical risk factors undergoing high-risk surgery. However, considering the patient's ECG changes were from 2 years ago and his regular activity level indicating a certain level of fitness, further clinical assessment and risk stratification is essential to determine the necessity of pre-operative cardiac testing. Key considerations include the patient's functional capacity, current symptoms, and the nature of the planned surgery. Administering thallium-201 during a stress test could be one such modality used to analyze heart function and blood flow if non-invasive testing is indicated based on the patient's risk profile.