Perioperative Myocardial Injury
Jack Brooker1, Alparslan Turan1
1Department of Outcomes Research, Anaesthesiology Institute, Cleveland Clinic, Cleveland, United States.
Turkish Journal of Anaesthesiology and Reanimation
|February 27, 2023
Summary
Postoperative cardiac troponin elevation, termed myocardial injury after non-cardiac surgery, is linked to increased mortality. Its true incidence and risk factors require further investigation.
Area of Science:
- Cardiology
- Perioperative Medicine
- Clinical Pathology
Background:
- Elevated cardiac troponin after non-cardiac surgery, even without infarction, correlates with adverse outcomes.
- Myocardial injury after non-cardiac surgery (MINS) is increasingly recognized but its incidence is unclear.
- The pathological mechanisms and risk factors for MINS are not fully elucidated.
Purpose of the Study:
- To review existing literature on myocardial injury after non-cardiac surgery.
- To summarize the current understanding of MINS incidence and its association with postoperative complications.
- To explore potential risk factors for MINS.
Main Methods:
- Literature review of studies published over several decades.
- Synthesis of evidence regarding postoperative troponin elevation.
- Analysis of reported complications and mortality associated with MINS.
Main Results:
- Postoperative troponin rise is associated with myocardial death and all-cause mortality.
- The exact incidence of MINS is unknown and likely underestimated.
- Risk factors for MINS are presumed similar to myocardial infarction due to shared pathology.
Conclusions:
- Myocardial injury after non-cardiac surgery is a significant concern with established links to mortality.
- Further research is needed to determine the precise incidence and risk factors for MINS.
- Understanding MINS is crucial for improving patient outcomes in non-cardiac surgical settings.
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
21
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
21
01:28Acute Coronary Syndrome IV: Interprofessional Care
19
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
19
01:21Myocarditis I: Introduction
16
Myocarditis is inflammation of the myocardium, which is the muscular layer of the heart.EtiologyMyocarditis has a diverse etiology, including a wide range of infectious and non-infectious causes:Infectious CausesViral: Common viruses include Coxsackie A and B, adenovirus, parvovirus B19, enteroviruses, and influenza A.Bacterial: Examples include infections caused by Streptococcus, Staphylococcus, and Mycoplasma species.Rickettsial: Infections like Rocky Mountain spotted fever can result in...
16
01:30Acute Coronary Syndrome I: Introduction
46
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
46
01:22Myocarditis IV: Nursing Management
17
Myocarditis is an inflammatory condition of the myocardium requiring meticulous nursing management for optimal patient outcomes. Effective management begins with a thorough assessment of the patient's medical history, paying close attention to past infections, autoimmune disorders, travel history, and exposure to toxins or drugs. Recent viral infections and systemic diseases are particularly relevant due to their potential role in triggering myocarditis.Physical Examination and MonitoringThe...
17