[Verse 1]
A vascular patient walks through the door,
Can't climb a flight, can barely do more,
Functional capacity under four METs,
The ACC/AHA algorithm resets,
We ask: is this surgery truly urgent care?
If not, we test — stress echo strips it bare,
Non-invasive workup, weigh the coronary risk,
RCRI score tallied, nothing hit or missed,
Elevated risk with poor capacity means
We dig for answers underneath the surface seams
[Chorus]
ACC slash AHA, step by step we go,
Urgent or elective, risk is what we know,
METs below four, the algorithm speaks,
Test if it changes management, not just for weeks,
Stent plus surgery — timing is the key,
Aortic stenosis — pressure gradients decree,
Self-assess your plan, question what you see,
Perioperative thinking, sharp and free
[Verse 2]
Four months out from a drug-eluting stent,
The antiplatelet therapy hasn't been spent,
Twelve months is the target before you stop,
But urgent surgery means the clock won't drop,
Clopidogrel pulled too soon invites catastrophe,
Stent thrombosis, MI, acute pathology,
Coordinate the surgeon, hematology in tow,
Continue aspirin through the case if you can go,
Discuss the bleeding risk against occlusion's toll,
Shared decision-making pulls the patient whole
[Chorus]
ACC slash AHA, step by step we go,
Urgent or elective, risk is what we know,
METs below four, the algorithm speaks,
Test if it changes management, not just for weeks,
Stent plus surgery — timing is the key,
Aortic stenosis — pressure gradients decree,
Self-assess your plan, question what you see,
Perioperative thinking, sharp and free
[Verse 3]
Severe aortic stenosis, valve area tight,
Hip fracture bleeding won't politely wait the night,
Mean gradient over forty, AVA below one,
The stenotic valve means cardiac output's nearly done,
Preload is the lifeline — don't let systemic drop,
Phenylephrine primed and ready at the stop,
Avoid tachycardia, keep the sinus rate,
Neuraxial caution — slow titration at the gate,
General or careful spinal, weigh it close,
Invasive arterial monitoring is the dose
[Bridge]
Ask yourself before the case:
What's the risk, what's the pace?
Did I calculate the RCRI?
Did I check the stent and timeline twice?
Is the preload safe, the gradient known?
Would I hand this plan to the attending — my own?
Self-assessment isn't doubt, it's calibration,
The sharpest tool inside the operating station
[Chorus]
ACC slash AHA, step by step we go,
Urgent or elective, risk is what we know,
METs below four, the algorithm speaks,
Test if it changes management, not just for weeks,
Stent plus surgery — timing is the key,
Aortic stenosis — pressure gradients decree,
Self-assess your plan, question what you see,
Perioperative thinking, sharp and free
[Outro]
Vascular risk, stent timing, stenotic valve,
Three scenarios — one standard, no shortcuts to halve,
The algorithm grounds you, the physiology leads,
Self-assessment seeds the practice that the patient needs