Which condition has the highest score on the Goldman scale and indicates the worst prognosis?

The Goldman scale is a scoring system used to assess the perioperative risk for patients undergoing non-cardiac surgery. It assigns points based on various clinical factors, with the total score correlating to the patient's risk of adverse cardiac events and overall prognosis.

Uncompensated congestive heart failure is one of the conditions that scores highest on the Goldman scale, indicating a significant increase in perioperative risk. Patients with this condition have poor cardiac function, which can lead to inadequate perfusion and exacerbate other underlying health issues during the stress of surgery. Their existing fluid overload and difficulty in maintaining stable hemodynamics compound these risks further, making the prognosis considerably worse.

In contrast, other factors like recent myocardial infarction, non-sinus rhythm, and frequent PVCs also contribute to increased risks, but they do not have the same level of severity and implications for immediate surgical risk as uncompensated congestive heart failure. Uncompensated heart failure represents a failure of the body to adapt, leading to more serious complications during the perioperative period. Thus, it is regarded as having the highest score on the Goldman scale, indicating the worst prognosis among the listed conditions.