Perioperative management of cardiac ischemia - Revision history

Aidan at 12:19, 2 August 2020

2020-08-02T12:19:06Z

← Older revision		Revision as of 12:19, 2 August 2020
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			== Background ==
⚫	* Highest risk period for MI is post-op day 3

	== Epidemiology ==		===Epidemiology===

	* Represents 1-6% of cardiac events		*Represents 1-6% of cardiac events

	== Etiology ==		===Etiology===

	* Bleeding (35%)		*Bleeding (35%)
	* Cardiac cause (44%), including MI, AV block, arrhythmias		*Cardiac cause (44%), including MI, AV block, arrhythmias
	* Other (21%), including PE, anaphylaxis, and hypoxemia		*Other (21%), including PE, anaphylaxis, and hypoxemia

	== Pathophysiology ==		===Pathophysiology===

	* Thrombosis		*Thrombosis
	* Catecholamine surges from stress state		*Catecholamine surges from stress state
	* Obstruction		*Obstruction
	* Infection or inflammation		*Infection or inflammation
	* Increased demand, from tachycardia, fever, hypotension, anemia, and hypoxemia		*Increased demand, from tachycardia, fever, hypotension, anemia, and hypoxemia

	== Clinical Manifestations ==		==Clinical Manifestations==

		⚫	*Highest risk period for MI is post-op day 3
	* Myocardial infarction after non-cardiac surgery (MINS)		*[[Myocardial infarction after non-cardiac surgery]] (MINS)
	* STEMI is rare		*[[STEMI]] is rare

	== Diagnosis ==		==Diagnosis==

	* Increased troponin with typical pattern		*Increased troponin with typical pattern
	* Signs of ischemia, including Q waves on ECG or wall motion abnormalities on echocardiography		*Signs of ischemia, including Q waves on ECG or wall motion abnormalities on echocardiography

	== Management ==		==Management==

	* Treat underlying cause		*Treat underlying cause
	* Add ASA and beta blocker, consider ACE inhibitor or nitrates		*Add ASA and beta blocker, consider ACE inhibitor or nitrates

	== Preoperative assessment ==		==Preoperative assessment==

	* If surgery is emergent, proceed to OR		*If surgery is emergent, proceed to OR
	* If not emergent, then rule out ACS and treat this first		*If not emergent, then rule out ACS and treat this first
	* If not having ACS, then risk stratify with AHA class or RCRI or NSQuIP		*If not having ACS, then risk stratify with AHA class or RCRI or NSQuIP
	* Elective surgery should be delayed for:		*Elective surgery should be delayed for:
	** Anticoagulation/antiplatelets		**Anticoagulation/antiplatelets
	** Electrolyte abnormalities		**Electrolyte abnormalities
	** Infection, especially pneumonia		**Infection, especially pneumonia
	** Obstructions in the vasculature (ACS or PE within the past month)		**Obstructions in the vasculature (ACS or PE within the past month)
	** Unstable vitals		**Unstable vitals

	== Prognosis ==		==Prognosis==

	* 15-25% in-hospital mortality		*15-25% in-hospital mortality
	* Outcomes are related to peak troponin (per VISION study)		*Outcomes are related to peak troponin (per VISION study)

	[[Category:Perioperative medicine]]		[[Category:Perioperative medicine]]

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-20T14:15:26Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 14:15, 20 July 2020
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	* Increased demand, from tachycardia, fever, hypotension, anemia, and hypoxemia		* Increased demand, from tachycardia, fever, hypotension, anemia, and hypoxemia

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* Myocardial infarction after non-cardiac surgery (MINS)		* Myocardial infarction after non-cardiac surgery (MINS)

Maintenance script: Imported from text file

2020-07-04T01:17:50Z

Imported from text file

New page

* Highest risk period for MI is post-op day 3

== Epidemiology ==

* Represents 1-6% of cardiac events

== Etiology ==

* Bleeding (35%)
* Cardiac cause (44%), including MI, AV block, arrhythmias
* Other (21%), including PE, anaphylaxis, and hypoxemia

== Pathophysiology ==

* Thrombosis
* Catecholamine surges from stress state
* Obstruction
* Infection or inflammation
* Increased demand, from tachycardia, fever, hypotension, anemia, and hypoxemia

== Clinical Presentation ==

* Myocardial infarction after non-cardiac surgery (MINS)
* STEMI is rare

== Diagnosis ==

* Increased troponin with typical pattern
* Signs of ischemia, including Q waves on ECG or wall motion abnormalities on echocardiography

== Management ==

* Treat underlying cause
* Add ASA and beta blocker, consider ACE inhibitor or nitrates

== Preoperative assessment ==

* If surgery is emergent, proceed to OR
* If not emergent, then rule out ACS and treat this first
* If not having ACS, then risk stratify with AHA class or RCRI or NSQuIP
* Elective surgery should be delayed for:
** Anticoagulation/antiplatelets
** Electrolyte abnormalities
** Infection, especially pneumonia
** Obstructions in the vasculature (ACS or PE within the past month)
** Unstable vitals

== Prognosis ==

* 15-25% in-hospital mortality
* Outcomes are related to peak troponin (per VISION study)

[[Category:Perioperative medicine]]
[[Category:Cardiology]]