Assessment and management of patients with ischemic heart disease
Shamsuddin Akhtar1, David G Silverman
1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA.
Insights
Patients with ischemic heart disease undergoing noncardiac surgery face significant risks. Guidelines and intensive pharmacologic therapy can improve outcomes, but clinical application remains challenging.
Area of Science:
- Cardiology
- Anesthesiology
- Perioperative Medicine
Background:
- Patients with ischemic heart disease undergoing noncardiac surgery are at high risk for cardiac complications.
- Recent guidelines aim to simplify preoperative cardiac risk assessment.
Purpose of the Study:
- To review the perioperative management strategies for patients undergoing noncardiac surgery, focusing on those with ischemic heart disease.
Main Methods:
- A literature review was conducted using PubMed and MEDLINE databases.
Main Results:
- Intensive perioperative pharmacologic therapy, including beta-blockers and alpha-2 agonists, can improve cardiovascular outcomes.
- Anesthetic technique is unlikely to significantly impact perioperative cardiac morbidity or mortality.
- Postoperative management focused on reducing hemodynamic stress is crucial.
Conclusions:
- Translating current guidelines into clinical practice requires a multidisciplinary approach.
- Improved diagnosis and management of perioperative myocardial infarction are needed, with cardiac biomarkers showing promise.
Objective:
Review the perioperative management of patients who are scheduled for noncardiac surgery.
Data Source:
Review of literature (PubMed, MEDLINE).
Conclusions:
Patients with ischemic heart disease who undergo noncardiac surgery are at significant risk of perioperative cardiac morbidity and mortality. Recent joint guidelines from the American College of Cardiology and American Heart Association have significantly streamlined the preoperative evaluation processes. Augmented hemodynamic control with intensive perioperative pharmacologic therapy with beta-blockers and possibly alpha-2 agonist has been shown to improve perioperative cardiovascular outcomes. However, translating this information to clinical practice continues to be a challenge and requires a multi- disciplinary approach. A particular intraoperative anesthetic technique is unlikely to influence perioperative cardiac morbidity and mortality. Postoperative management with goals of decreasing hemodynamic stress is important in patients with ischemic heart disease. Diagnosis and management of perioperative myocardial infarction continues to be a challenge. However, use of cardiac specific biomarkers should improve the diagnostic process.
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