Harvard Heart Letter

Ask the doctor: What does my doctor mean by "clearance for surgery"?

Q. I had a small heart attack last year when I was undergoing an operation to remove part of my colon. I am doing fine in that regard, but now I need cataract surgery, and my ophthalmologist has sent me to my internist for "clearance" before surgery. Does this mean my risk for another heart attack is high?

A. If you are not currently having chest pain, marked shortness of breath, fainting, near-fainting spells, or other symptoms of heart disease, your risk of having heart problems with cataract surgery are very, very low. Cataract surgery puts very little—if any—strain on the heart, and complications are rare. That said, ophthalmologists do not provide care for heart problems, and they tend to err on the side of caution by getting more expert assistance in assessing risks for surgery. So don't be unnerved by this referral by your ophthalmologist—it is a fairly routine practice, even for patients with no history of heart disease.

It is worth noting, however, that the term "clearance" is a bit misleading. No consultant can guarantee there will be no complications. The real questions are whether the chances of having a heart problem during cataract surgery might be high enough that special steps should be taken to reduce it, or that consideration should be given to cancelling the operation. In your case, the answers to those questions are almost surely "no."

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