In 1977 Goldman, et al., developed the first cardiac risk index for patient

Patient

A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....

s above 40 years of age about to be operated by looking at nine variables, which increased the risk of perioperative cardiac complications. These variables are

• preoperative third heart sound or jugular venous distention
• myocardial infarction
  Myocardial infarction
  Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
  
   in the preceding six months
• more than five premature ventricular contraction
  Premature ventricular contraction
  A premature ventricular contraction , also known as a premature ventricular complex, ventricular premature contraction , ventricular premature beat , or extrasystole, is a relatively common event where the heartbeat is initiated by the heart ventricles rather than by the sinoatrial node, the...
  
  s per minute documented at any time before operation
  Surgery
  Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
  
  
• cardiac rhythm other than sinus rhythm
  Sinus rhythm
  In medicine, sinus rhythm is the normal beating of the heart, as measured by an electrocardiogram . It has certain generic features that serve as hallmarks for comparison with normal ECGs.- ECG structure :...
  
   or presence of premature atrial contraction
  Premature atrial contraction
  Premature atrial contractions , also known as atrial premature complexes or atrial premature beats , are a common cardiac arrhythmia characterized by premature heartbeats originating in the atria...
  
  s on preoperative electrocardiogram
  Electrocardiogram
  Electrocardiography is a transthoracic interpretation of the electrical activity of the heart over a period of time, as detected by electrodes attached to the outer surface of the skin and recorded by a device external to the body...
  
  
• age over 70 years
• intraperitoneal, intrathoracic or aortic operation
• emergency operation
• important aortic valvular stenosis
• poor general medical condition

Since 1977, multiple cardiac risk indices and guidelines for preoperative cardiac evaluation have been developed.