A patient needs noncardiac surgery two months after myocardial infarction. What is the initial preoperative cardiac test to obtain?

• A. Electrocardiogram
• B. Chest X-ray
• C. Echocardiography
• D. Cardiac MRI

Answer: (A)

The key idea is that after a recent myocardial infarction, the first step in preoperative evaluation is to obtain a baseline electrocardiogram. An ECG is quick, noninvasive, and inexpensive, and it screens for ongoing ischemia, rhythm disturbances, or conduction problems that could complicate surgery. It helps identify immediate issues that might require further testing or optimization before proceeding.

If the ECG is normal and the patient is hemodynamically stable, you can often proceed with careful perioperative management and reserve more advanced testing for when it’s indicated by symptoms, ECG findings, or reduced functional capacity. If the ECG shows abnormalities or if there’s concerning symptoms, then further assessment (such as echocardiography to evaluate left ventricular function or noninvasive stress testing to assess inducible ischemia) would be pursued.

Chest X-ray provides structural information but not specific ischemia risk, echocardiography or cardiac MRI give detailed imaging of structure and function but aren’t the initial screen in this scenario.