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[Perioperative myocardial ischemia in patients with peripheral arterial occlusive diseases]
H J Rapp1, P Buselmeier, P Gasteiger
1Institut für Anaesthesiologie und Operative Intensivmedizin am Klinikum der Stadt Mannheim, Fakultät für Klinische Medizin, Universität Heidelberg.
Insights
Peripheral vascular disease patients frequently have silent myocardial ischemia, detected via Holter monitoring. This silent ischemia occurs preoperatively and during the perioperative period, highlighting cardiac risks in PVD patients.
Area of Science:
- Cardiology
- Vascular Surgery
- Anesthesiology
Context:
- Patients with peripheral vascular disease (PVD) often have coexisting coronary artery disease (CAD), increasing perioperative risks.
- Diagnostic stress tests are challenging in PVD patients due to claudication.
- Coronary artery disease affects nearly 50% of PVD patients.
Purpose:
- To evaluate the frequency of transient perioperative myocardial ischemia in PVD patients undergoing femoropopliteal bypass surgery.
- To assess the timing of myocardial ischemia in relation to anesthesia and surgery.
Summary:
- Holter monitoring with ST-segment analysis was performed on 30 PVD patients (ASA II-III, Fontaine II-IV) undergoing bypass surgery.
- Exclusion criteria included left bundle branch block, left ventricular hypertrophy, and digitalis use.
- Myocardial ischemia was detected in 26% of patients (n=19), with 75% occurring preoperatively and 25% perioperatively.
Impact:
- Silent myocardial ischemia is prevalent in a significant subset of PVD patients.
- ST-segment analysis of Holter recordings provides insight into cardiac status during perioperative intervals.
- Findings suggest the need for further studies in larger populations to confirm the association between PVD and silent ischemia.
Abstract:
Patients with peripheral vascular disease (PVD) often have coronary artery disease (CAD) which means an increased risk during anesthesia. The prevalence of CAD is nearly 50% among such patients. Owing to claudication, diagnostic stress tests can rarely be performed in PVD patients. In order to evaluate the frequency of transient perioperative myocardial ischemia, Holter monitoring was performed in 30 consecutive PVD patients with ASA II-III and AVK scale (Fontaine) II-IV who were undergoing femoropopliteal bypass surgery. Patients who had left bundle branch block and left ventricular hypertrophy or were taking digitalis medication were excluded from Holter monitoring. The ST-segment analysis of the frequency modulated recordings (n = 19) revealed episodes of myocardial ischemia in 26% of the patients. Most (75%) of the episodes occurred preoperatively, and 25%, during or after the anesthesia or during preparation for it. Risk factors for CAD were more often found in patients with ST segment alterations than in patients without ST segment deviations, even though the preoperative antianginal medication administered was comparable in the two subgroups. It is concluded that in a considerable subset of PVD patients silent myocardial ischemia occurs, which can be related to the different perioperative intervals by means of ST segment analyses of Holter recordings. The ST segment may allow a better insight into the cardiac state of PVD patients. Further studies are necessary in larger populations to test our suspicion.