Cardiac risk calculators

Detsky and Goldman calculators

History

Goldman

Detsky

Age > 70 years

Myocardial infarction:

within 6 months

beyond 6 months

never

10,0

10,5

Alveolar pulmonary oedema:

ever

within 1 week

never

5,10

Angina (Candian Heart Association classification)

Goldman

Detsky

Class III

Class IV

neither

10,20

Unstable angina within 3 months

Cardiac Exam	Goldman	Detsky
Signs of congestive heart failure (S3 gallop or Jugular Distension)	11	NA
Significant aortic stenosis / suspected critical aortic stenosis	3	20

Electrocardiogram	Goldman	Detsky
Arrhythmia other than sinus or premature atrial contractions	7	5
5 or more PVCs per minute any time before surgery	7	5

General Medical Condition (any of these:)	Goldman	Detsky
PO2 < 60mmHg (8kPa); PCO2 > 50mmHg (6.7kPa); K < 3mmol/l; HCO3 < 20mmol/l; urea >18mmol/l (BUN > 50mg/dl); Creatinine > 260umol/l (3mg/dl); elevated SGOT (aspartate aminotransferase); chronic liver disease; bedridden from non-cardiac cause	3	5

Operation

Goldman

Detsky

Emergency

Intraperitoneal or intrathoracic

Vascular - aortic

Vascular - carotid

Vascular - peripheral

Orthopaedic

Head & neck

Minor surgery

None of the above

Goldman analysis:	N.Engl.J.Med. (1977) 297:845
Total score :	Equates to a risk of complications (ie cardiac death, documented intra- or postoperative MI, pulmonary oedema or nonfatal ventricular tachycardia)

Detsky analysis:

J Gen Int Med (1986) 1:211

Arch Intern Med (1986) 146:2131

Total score :

Equates to a risk of severe complications (ie cardiac death, MI, alveolar pulmonary oedema)

Equates to a risk of serious complications (ie as above plus coronary insufficiency and new or worsened congestive cardiac failure without alveolar pulmonary oedema)

Canadian Heart Association angina classification:

Class I Ordinary physical activity, such as walking and climbing stairs, does not cause angina. Angina with strenuous, rapid or prolonged exertion at work or recreation.

Class II Slight limitation of ordinary activity. Walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, in the cold, in wind or when under emotional stress, or only during the few hours after awakening. Walking more than two blocks on the level and climbing more than one flight of ordinary stairs at a normal pace and at normal conditions.

Class III Marked limitation of ordinary physical activity. Walking one to two blocks on the level and climbing more than one flight in normal conditions.

Class IV Inability to carry on any physical activity without discomfort - anginal syndrome may be present at rest.

Class I	Ordinary physical activity, such as walking and climbing stairs, does not cause angina. Angina with strenuous, rapid or prolonged exertion at work or recreation.
Class II	Slight limitation of ordinary activity. Walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, in the cold, in wind or when under emotional stress, or only during the few hours after awakening. Walking more than two blocks on the level and climbing more than one flight of ordinary stairs at a normal pace and at normal conditions.
Class III	Marked limitation of ordinary physical activity. Walking one to two blocks on the level and climbing more than one flight in normal conditions.
Class IV	Inability to carry on any physical activity without discomfort - anginal syndrome may be present at rest.