Goal: minimize post-op cardiac event
HPI- active chest pain
Exercise capacity MET score ( metabolic equivalent ) >4  good!
RCRI revised cardiac risk index, ( % risk death after surgery )
1. surgery type 
high risk- vascular/emergency/abdominal sx
moderate risk- ortho/eye
2. History of stroke -optimize with ASA and statin. 
3. CAD -optimize with bb, asa, acei
4. CHF -make  Euvolemic, Lasix, core measure of diastolic or systolic CHF
5. DM glucose control
6. CKD if stage >2 ok

Let's say MET and RCRI
MET >4, RCRI <1  patient may go for surgery at average risk
MET >4, RCRI >1 the same
MET <4, RCRI <1 the same
MET <4, RCRI >1 no surgery and cardiac workup! cardiology evaluation before surgery. 

Let's talk about prior MI
<1 mon no!
<6 mon DAPT no good
>6 mon OK go for surgery

Let's make it concise
1. HPI chest pain
2. MET  and RCRI
3. Medication  - AC (warfarin or DOAC), Steroid
4. Lab : INR <1.5, PLT >50K, neurosurgery need PLT >100K. 
prior surgery INR <1.5 is the goal.
(4) AC and steroid
Warfarin stop 48 hrs before surgery  for major surgery
Warfarn stop 24 hrs before surgery for minor
surgery
DOAC needs KCENTRA reverse agents
Steroid
H-H-Axis control, prednisone 5mg 3 weeks, be careful with potential adrenal shock!
A.fib ppx , AC can be stopped without bridging with heparin
DVT, PE, bridging:  heparin stop 6 hrs before surgery. 
AV placement: stop warfarin, ok
MV placement: bridging needed