Practical approaches to cardiac clearance in nontraditional clinical scenarios.

Abstract

"Cardiac clearance" is frequently sought from clinicians before noncardiac procedures or activities that lack expert consensus guidelines regarding cardiovascular risk evaluation. In 2023, our research group published a review article in TheAmerican Journal of Medicine which summarized the evidence and recommendations for six "nontraditional" requests for cardiovascular risk evaluation. Since then, our group continued to receive similar requests. Here, we review the known literature and provide management recommendations for six more requests inspired by real referrals received by the authors. These requests highlight increasingly common therapies including hyperbaric oxygen therapy for wound healing, ketamine for treatment-resistant depression, antipsychotic therapy, and proton therapy to the chest. We also comment on the cardiovascular risk evaluation of being in a strenuous profession as a law enforcement officer and taking part in the less strenuous activity of bowling. Ultimately, we recommend taking a standardized, patient-centered approach to every cardiovascular risk evaluation, first learning about the procedure or activity, then understanding the pertinent physiology, and finally exploring the available literature regarding management.