Nokea
A 75-year-old lady is listed for an anterior resection to treat a cancer in the descending hemicolon. She has never previously been in hospital. She gives no history of shortness of breath or angina, but admits that she does not take part in strenuous activity. Apart from painkillers, she takes no medications. Appropriate statements regarding preoperative testing include:
Correct Answer: C
Rationale: Preoperative assessment evaluates surgical risk. Resting echocardiography assesses cardiac structure, not functional capacity, which requires dynamic testing. Coronary angiography is invasive and unwarranted without symptoms like angina or ischemia evidence. Cardiopulmonary exercise testing (CPET) measures aerobic capacity (e.g., VOâ‚‚ peak), directly assessing functional reserve for surgical stress ideal for this asymptomatic but inactive patient. Brain natriuretic peptide (BNP) indicates heart failure if elevated but doesn't test capacity; it's a biomarker, not a stress test. Dobutamine stress echocardiography detects ischemia, useful but less comprehensive than CPET for overall fitness. CPET's ability to quantify cardiopulmonary reserve makes it the most appropriate choice for optimizing perioperative management in this elderly patient.