Quick answer
What Is Preoperative Heart Screening?
Preoperative heart screening is a heart assessment before you undergo non-cardiac surgery, for example bone, abdominal, or cancer surgery. Your doctor asks about symptoms and your ability to be active, performs a physical examination, then orders an ECG and blood tests according to your risk. The result is a recommendation on risk, medicine management, and surgery timing.
Sources01 / Understanding the procedure
About Preoperative Heart Screening
What Is Preoperative Heart Screening
Preoperative heart screening is an assessment of the heart and blood vessels before non-cardiac surgery. Surgery and anesthesia put extra strain on the heart, so people with heart disease or certain risk factors are more likely to have complications. This assessment helps the surgeon, anesthesiologist, and cardiologist plan the surgery as safely as possible.
How It Works in Brief
Your doctor combines two things: the risk of the type of surgery and your own condition. Minor surgery such as eye or skin surgery is low risk, while major surgery on the abdomen, chest, or blood vessels carries a higher risk. On the patient side, your doctor assesses your age, heart disease, blood sugar, kidney function, and ability to be active, for example whether you can climb two flights of stairs without stopping. Additional tests are only ordered if the results would change the plan.
What Is Usually Checked
- Interview and physical examination: symptoms, medical history, medicines you take, and your ability to be active.
- ECG: especially if you have heart disease or risk factors and are scheduled for moderate to major surgery.
- Blood tests: such as hemoglobin, kidney function, and blood sugar; in certain patients also NT-proBNP or troponin.
- Echocardiography: if you have shortness of breath, a new heart murmur, or suspected heart failure or valve narrowing.
- Stress test: only in a small number of patients with low activity capacity who are having high-risk surgery.
Results and Recommendations
The screening result is not simply a yes or no for surgery. Your doctor gives a recommendation: the surgery can go ahead, your condition needs to be improved beforehand, for example blood pressure or heart failure, or planned surgery should be postponed if there is an active heart problem. The recommendation also covers which medicines to continue or stop temporarily, how blood thinners are managed, and monitoring after surgery.
02 / Understanding the procedure
When Is This Procedure Considered?
A doctor may consider this procedure in the situations below. The decision is always made after a thorough assessment.
- Older Age Before Moderate or Major SurgeryHeart risk increases with age.
- History of Heart DiseaseSuch as coronary artery disease, heart failure, valve disease, or rhythm disorders.
- Heart Risk FactorsHypertension, diabetes, chronic kidney disease, or a history of stroke.
- Symptoms Not Yet CheckedChest pain, shortness of breath, palpitations, or a history of fainting.
- Taking Blood Thinners or AntiplateletsA safe plan for stopping and restarting them is needed.
- Having a Pacemaker or ICDDevice settings may need adjusting during surgery.
Situations to Consider First
- Emergency SurgerySurgery is not delayed for testing; the assessment is done at the same time.
- Active Heart SymptomsPlanned surgery should be postponed until your condition is stable.
- Recent Heart Attack or Stent PlacementThe timing of planned surgery is adjusted to how long antiplatelet medicines need to be taken.
- Not Bringing Medication Details and Previous ResultsThe assessment becomes less complete; bring your medication list and test results.
03 / Before the procedure
How Should You Prepare?
Come a few days to a few weeks before your planned surgery date, so there is time for tests or medicine adjustments if needed.
Surgery information. Bring details of the type of surgery, the expected date, and the name of the surgeon or the hospital where the surgery will take place.
Medicines. Bring a list of all your medicines and supplements, especially blood thinners, antiplatelets, diabetes medicines, and blood pressure medicines. Do not stop any medicine on your own.
Previous results. Bring any ECG, echocardiography, or catheterization results or letters from your cardiologist, as well as your pacemaker or ICD card if you have one.
Fasting. Usually not needed, unless certain blood tests require it.
Unsure about the preparation instructions? Ask our team before the procedure.
04 / During the procedure
How Is the Procedure Done?
A consultation with an ECG and basic blood tests is usually finished in about 1 hour. If echocardiography or a stress test is needed, the examination may take longer or be scheduled separately.
Interview and Physical Examination
Your doctor asks about symptoms, medical history, medicines, and your ability to do daily activities, then checks your blood pressure, pulse, heart sounds, and lungs.
ECG and Blood Tests
The ECG is recorded in a few minutes, and blood is drawn as needed, for example for hemoglobin, kidney function, blood sugar, or NT-proBNP.
Additional Tests If Needed
Echocardiography or a stress test is done only if the results would change the surgery or treatment plan.
Written Recommendation
Your doctor writes down the estimated risk, the medicine plan, the recommended timing of surgery, and the need for monitoring after surgery, to be discussed with the surgeon and anesthesiologist.
05 / Benefits and risks
Benefits and Risks Should Be Discussed Together.
Every medical procedure has benefits and risks. Your doctor will explain both for your situation before the procedure.
Benefits You Can Expect
- Lower Risk of Heart ComplicationsProblems that can be fixed are treated before surgery.
- Safe Medicine ManagementIncluding blood thinners and antiplatelets after a stent.
- The Right Timing for SurgeryPlanned surgery is scheduled when your heart is ready.
- Only the Tests You NeedAdditional tests are only ordered if they would change the plan.
- Team CoordinationThe written recommendation helps the surgeon and anesthesiologist.
The benefits of a procedure are not a promise of a cure. Ask how the results will affect your care plan.
Risks You Should Know
- Surgery May Be PostponedIf there is a heart problem that needs to be treated beforehand.
- Additional TestsSome patients need echocardiography or a stress test.
- Risk Is Not Fully EliminatedScreening lowers risk but does not remove it.
- Mild Bruising from the Blood DrawMild and goes away on its own.
Risks can differ from person to person. A full explanation and consent are given after an individual assessment.
06 / After the procedure
What Is Recovery Like?
There is no recovery period. You can return to your activities right after the examination.
Follow the medicine plan. Stick to the schedule for stopping and restarting medicines according to the written recommendation, and share it with your surgeon and anesthesiologist.
After surgery. In patients at higher risk, your doctor may check troponin or repeat the ECG to detect heart problems that often cause no symptoms.
Warning signs. Before or after surgery, tell the medical team or go to the emergency room right away if you have:
- Chest pain or shortness of breath
- A very fast or irregular heartbeat
- Severe dizziness or fainting
- New swelling in the legs
Know the Signs That Need Prompt Care.
Follow the team's guidance on warning signs. If severe or sudden symptoms appear after the procedure, go to the nearest emergency department right away or call Heart Attack Center 1500 258.
07 / Team and support
Doctors and Procedure Support
The doctors below are listed for this procedure. Listed by name, not by ranking.
dr. Debby C. Soemitha, Sp.PD
Internal Medicine
Clinical focusDiabetes and Diabetes Complications · Obesity and Metabolic Disease
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Dr. med. dr. Denio A. Ridjab, Sp.JP(K)
Interventional Cardiology
Coronary Intervention Procedures +2 centers
Clinical focusInterventional Cardiology · Coronary Artery Disease
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dr. Santi R. Dewayanti, Sp.P
Pulmonology
Clinical focusLung and Respiratory Disease · Asthma and COPD
View Profile08 / Common questions
Before You Plan the Procedure.
Frequently asked questions about heart screening before surgery. Recommendations for your condition are explained by your doctor.
Does everyone need heart screening before surgery?
No. For minor surgery in people without heart disease or risk factors, a routine assessment by the surgeon and anesthesiologist is usually enough. Heart screening is more strongly recommended if you are older, have heart disease or risk factors, have symptoms, or are having moderate to major surgery.
Do I have to stop taking my blood thinners?
It depends on the type of medicine, your kidney function, the bleeding risk of the surgery, and the reason you take it. Some medicines are stopped a few days before surgery, while others are continued, for example aspirin in many patients. Your doctor will write down when to stop and when to restart the medicine. Do not stop it on your own.
How long should surgery be postponed after getting a stent?
For planned surgery, guidelines generally advise waiting about 6 months after a planned stent placement and about 12 months after a heart attack, so that dual antiplatelet therapy can be taken for long enough. If the surgery cannot wait, your cardiologist and surgeon will weigh a safe middle ground.
Why does my doctor ask whether I can climb stairs?
Your ability to be active is a simple indicator of how strong your heart and lungs are. People who can climb two flights of stairs or walk briskly without shortness of breath or chest pain usually have a lower risk of heart complications during surgery. If this ability is low, your doctor may order additional tests.
Do the screening results guarantee that my surgery will be safe?
No test can remove all risk. Screening helps find and fix problems that can be treated, prepare your medicines safely, and plan the right monitoring, so the risk of heart complications becomes lower. The final decision is made together by the surgeon, the anesthesiologist, and you.
What if I have a pacemaker or ICD?
Bring your device card to the screening. The electrical tool used to stop bleeding during surgery can interfere with how a pacemaker or ICD works, so the device settings may need to be changed temporarily before surgery and restored afterward. Your cardiologist will coordinate this with the surgical team.
Sources and Medical Review
Translated from the Indonesian edition medically reviewed by dr. Siska S. Danny, Sp.JP(K).
Sources as cited in the Indonesian edition.
- Halvorsen S, Mehilli J, Cassese S, et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J. 2022;43(39):3826-3924.
- Thompson A, Fleischmann KE, Smilowitz NR, et al. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery. Circulation. 2024;150(19):e351-e442.
- Duceppe E, Parlow J, MacDonald P, et al. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. Can J Cardiol. 2017;33(1):17-32.
- Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100(10):1043-1049.