Do I need a cardiac workup before surgery?

I am going to have open surgery (not laparoscopic) for repair of a hiatal hernia. Two years ago I had two
critical levels for hemoglobin (3.5) and hematocrit, and needed a blood transfusion. After lots of tests, they never discovered any reason for the loss of blood. I had a lot of vomitting after eating, from the hiatal hernia. Presently, I often get severe chest pain from the hernia after eating even just a few bites of food. When I had a physical last month, my blood pressure was very high (it had always been about 110/70), a heart murmur was discovered (never had one before), and I get palpitations now and then. My NP seems to feel the high blood pressure is due to anxiety over the surgery and from the severe chest pain. I had an endoscopy, and my blood pressure was 168/99. I keep checking my pressure, and the lowest it has been is about 148/95. I am really worried about this before open surgery for the hernia. That is a major procedure, and I will be hospitalized for 5-6 days and cannot return to work for 4-6 weeks. Should I ask the NP to do a cardiac work-up before the surgery? She seems to feel it's all anxiety/pain related and nothing needs to be done right now. I am not sure I feel good about that. Can anyone help me with my decision

[Cleveland Clinic]

You are correct that this is not a minor surgery, but it considered moderate surgery by most standards. If you have a history of coronary artery disease, low functional capacity ( cannot walk 1 block on level ground or up one flight of stairs), then you may need a stress test prior to the surgery. If not then you need to be started on a beta blocker both for blood pressure control and to reduce peri-operative risk of myocardial infarction.

[maggiemae88]

I will talk to the NP about that when I go in next week.  She had said that she didn't feel I should be started on any medication before surgery in the event that this was just anxiety/pain related because then my blood pressure would plummet, and this would not be good either.  At this point, she feels just checking the pressure once a week is all that's needed.  I have been checking it daily, and it never lowers.  Thanks for your help.