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Published on: June 11, 2020
The diagnosis and perioperative management of myocardial ischaemia
1Department of Anaesthesia, St. Michael's Hospital, University of Toronto, Canada.
Insights
Perioperative myocardial ischemia is frequent in patients with coronary artery disease (CAD), often occurring silently. Monitoring and maintaining hemodynamic stability are key, with further improvements expected from postoperative care.
Area of Science:
- Cardiology
- Anesthesiology
- Cardiovascular Surgery
Background:
- Perioperative myocardial ischemia is a significant concern in patients with or at risk for coronary artery disease (CAD).
- Ischemic episodes frequently occur during the pre-, intra-, and postoperative phases.
- A majority of these perioperative ischemic events are asymptomatic (silent).
Purpose of the Study:
- To highlight the prevalence and characteristics of perioperative myocardial ischemia.
- To discuss diagnostic and monitoring strategies for perioperative ischemia.
- To emphasize the importance of hemodynamic stability and postoperative care.
Main Methods:
- Review of existing literature on perioperative myocardial ischemia.
- Discussion of diagnostic tools, including preoperative laboratory investigations and electrocardiography (ECG).
- Emphasis on hemodynamic monitoring and management strategies.
Main Results:
- Perioperative myocardial ischemia is common in patients with CAD.
- Silent ischemia is prevalent, lacking typical angina symptoms.
- ECG is the optimal monitor for ischemia, and hemodynamic stability is crucial but not always causative.
Conclusions:
- Preoperative assessments aid in CAD diagnosis and risk prediction.
- Effective ECG monitoring and hemodynamic management are vital.
- Expanding efforts to the postoperative period is expected to enhance patient outcomes.
Conclusion:
Perioperative myocardial ischaemia is common in patients who have or are at risk of coronary artery disease, occurring frequently in the pre-, intra- and postoperative periods. The majority of perioperative ischaemic episodes are silent, being unaccompanied by any symptoms of angina. The use of appropriate preoperative laboratory investigations may help in the diagnosis of CAD and the prediction of risk of adverse cardiac outcome. A properly placed and properly calibrated ECG is the best overall monitor of ischaemia. Maintenance of haemodynamic stability is important to reduce the incidence of myocardial ischemia, but ischaemia may occur in the absence of adverse haemodynamic changes. Although our efforts have largely been devoted to the prevention and treatment of intraoperative ischaemia, it is hoped that similar efforts outside the operating room in the postoperative period will further improve patient care and outcome.
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