Should patients at low-to-moderate cardiac risk receive beta-blockers before undergoing noncardiac surgery?
A 74-year-old female is admitted to the orthopedic service after a fall, which resulted in a left femoral-neck hip fracture requiring surgical repair. The hospital internal medicine service is consulted for a preoperative medical examination. Her medical history is significant for hypertension, hyperlipidemia, type 2 diabetes mellitus, and an ischemic stroke 2 years ago. She has no history of coronary artery disease or heart failure and denies any history of exertional angina, dyspnea, palpitations, dizziness, or recent syncope. At the time of the examination, the patient’s only complaint is left hip pain. Vital signs are within normal limits. Cardiac, pulmonary, and abdominal examinations are unremarkable. Her left leg is shortened and externally rotated but neurovascularly intact. Results of laboratory studies are unremarkable. Chest radiography and electrocardiography are normal. The patient’s medication list includes hydrochlorothiazide, 25 mg daily; simvastatin, 20 mg at night; me
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