February is often associated with heart health awareness, a time when many focus on eating right, exercising, and recognizing the signs of heart attack and stroke. As a urologist, however, I see a different side of heart health every day. Many of my patients require "cardiac clearance" before undergoing urological surgery. Yet, most patients have little understanding of what this process entails—or how crucial it can be for surgical outcomes. Contrary to popular belief, cardiac clearance isn't just a quick stamp of approval from a heart doctor. It's a comprehensive assessment that can reveal hidden heart issues, reduce surgical risk, and sometimes even save a life.

The Misconceptions Surrounding Cardiac Clearance

When patients hear "cardiac clearance," many assume it's a routine checkup that rarely uncovers anything significant. I've heard everything from "this is a waste of time" to "you're trying to delay my surgery." These reactions are understandable but misguided. While not every patient requires a medical assessment, for those with certain risk factors—such as heart disease, high blood pressure, or a family history of cardiac issues—it can be essential.

Cardiac clearance is a deep evaluation of how well your heart can tolerate the stress of surgery. During most operations, even those unrelated to the heart, your cardiovascular system needs to handle anesthesia, medications, and changes in blood flow. For people with existing heart disease, high blood pressure, or a family history of cardiac issues, this added strain can be risky.

The Process of Cardiac Clearance

For the clearance evaluation, a cardiologist or primary care physician might run tests such as an electrocardiogram (ECG), an echocardiogram, or a nuclear stress test to detect any irregularities or signs of disease, such as arrhythmias, valve problems, or blockages. If a hidden issue is uncovered, addressing it before surgery is critical for your safety and may lead to a quicker post-surgical recovery.

It might seem odd for a urologist—someone who deals with kidney stones, prostate concerns, and other urinary tract issues—to be so focused on heart health. But here's the reality: Every system in the human body is connected, and surgery puts significant strain on the heart and blood vessels. If there is an unrecognized blockage or poorly managed blood pressure, that stress can quickly escalate into a life-threatening complication in the operating room.

The Importance of Cardiac Clearance in Urology

In my practice, some of the most critical cases have been patients who needed urgent procedures—such as treating urological cancers or obstructing kidney stones—but hadn't addressed underlying cardiovascular risks. Instead of rushing the patient into surgery and risking a catastrophic event, my team and I take the time to ensure the heart is stable. Yes, it can feel frustrating to delay treatment, but that brief pause could literally save a life.

Once everything checks out, medical providers can move forward confidently, knowing we have done our due diligence. That's why cardiac clearance is a cornerstone of preoperative planning—and why surgeons like me take it so seriously.

What to Expect During Cardiac Clearance

When you're referred for cardiac clearance, expect your doctor to begin with a thorough review of your risk factors. This includes questions about your family history of heart disease, any lifestyle habits such as smoking or exercise routines, and whether you have conditions such as hypertension or diabetes. It's essential to be honest during this assessment—don't downplay symptoms or concerns just because you're eager to have the procedure.

Next, you'll likely undergo basic screenings, starting with an electrocardiogram to evaluate your heart's electrical activity and blood work to check cholesterol levels, diabetes risk, and other key markers. Depending on your overall health background, you may also need imaging studies or a stress test in which your heart's response to exertion is closely monitored through tools such as an echocardiogram or treadmill test.

Finally, if you're taking blood thinners or other medications for blood pressure, these prescriptions might be adjusted to reduce any potential risks during surgery.

A Real-Life Example

I recently treated a patient who needed surgery to address a potential cancer diagnosis. She was upset when I insisted on cardiac clearance first, worried about delaying treatment. But the tests revealed a major blockage in her heart—something that could have triggered a heart attack under anesthesia. My team and I paused for a few weeks, coordinated with cardiology to treat the blockage, and set her up for our procedure when it was safe. Ultimately, she got the surgery she needed and made it through without a cardiac emergency. That short wait and evaluation likely saved her life and made no difference in her long-term cancer outcome.

The Broader Implications of Cardiac Clearance

In February, most conversations about heart health focus on prevention—monitoring cholesterol, embracing exercise, cutting back on salt and sugars. But cardiac clearance is another key piece of the puzzle, especially if you're heading into the operating room. It's a thorough evaluation designed to uncover hidden risks, protect you during surgery, and give you the knowledge to manage your heart health going forward.

A cardiac clearance appointment isn't just a box to check off. If your surgeon requires cardiac clearance, embrace the process. It's to ensure your body is ready for the stress of an operation. Too many people put off heart checkups because they feel fine, but conditions such as high blood pressure or coronary artery disease can remain silent for years. So this can also be a golden opportunity to catch early warning signs of serious cardiovascular disease.

Heart health can change over time—especially as we age. If testing flags something such as borderline high blood pressure or elevated cholesterol, your doctor may suggest follow-up visits or medication to keep things under control long after you have healed from surgery. And even if you're not facing surgery, you can still get a heart health checkup. Maybe you've been delaying that overdue physical or have some heart pain you've tried to ignore. Let American Heart Month be your reason to finally schedule an exam to check your blood pressure, watch your cholesterol, and schedule those all-important appointments with your doctors.

In conclusion, cardiac clearance is not just a preoperative formality; it's a vital step in ensuring patient safety and optimizing surgical outcomes. Whether you're facing surgery or simply looking to take better care of your heart, understanding the importance of cardiac clearance can make a significant difference in your overall health and well-being.