Is ASA 1 really ASA 1?

It is not unusual for an anesthesiologist to feel a slight sense of relief when his/her pre anesthetic evaluation reveals an ASA1 (American Society of Anesthesiologists class 1) patient. My motivation to report this case is to contradict this very fact that a simple ASA1 patient can be the one who lands up in complications. A 28 year old male was posted for repair of ACL (anterior cruciate ligament) tear following a sports injury. Pre anesthetic evaluation was completely normal. We chose CSE (combined spinal epidural) anesthesia for him. After 10 minutes of surgery he developed SVT (supraventricular tachycardia) which came in paroxysms of 5-10 minutes. He initially responded to vagal maneuvers but stopped responding during the second paroxysm after which we administered adenosine 12mg after which it immediately subsided. We terminated the surgery and sent him to our cardiology department. Further testing revealed MVP (mitral valve prolapse) with MR (mitral regurgitation) (Grade 1). He was put on beta blockers and discharged after 3 days. MVP can have several complications like bacterial endocarditis, severe MR, and sudden death. MR is the most common complication. Does this mean we must subject every ASA1 patient to several investigations? No, unnecessary investigations are unethical, more traumatizing to patients and definitely not cost effective. Our case however draws light on the importance of vigilance and having a high index of suspicion and treat every patient with equal importance whether ASA 1 or ASA 4.