Patients with underlying heart blockages or those with risk factors are at increased risk for perioperative heart attacks. Perioperative period is the time period extending from when the patient goes into the hospital for surgery until the time he/she is discharged home.
The largest data on the subject comes from over 8000 patients in the randomized POISE trial of perioperative beta-blocker therapy, which has shown that at 30 days after the surgery the incidence of heart attack is 5 percent and 71 percent of these occur within 48 hours of surgery. Approximately 65 percent of patients with heart attack are without symptoms.
Therefore, perioperative heart attack is not uncommon and occurs with increasing frequency as the number of identified risk factors increases. Both short- and long-term survival are decreased in patients who have sustained a perioperative heart attack.
Treatment for perioperative heart attack is same as for any heart attack in the general population. However anticlotting drugs should be started carefully.
Perioperative heart attack is detected by presence of an elevated heart muscle injury blood test (troponin) and one or more of the following: ischemic (heart pain) symptoms, ECG changes in two contiguous leads, coronary artery intervention (balloon dilatation or stenting), or evidence of heart attack on cardiac echocardiography or autopsy.
All high-risk patients with cardiac troponin both before and after non cardiac surgery should be screened in order to detect a perioperative heart attack. Cardiac troponin levels should be measured for the following patients:
a. Patients with symptoms or ECG changes suggestive of ischemia or heart attack (2 or 3 serial biomarkers).
b. Patients at high cardiac risk (at 6 to 12 hours, and days 1, 2, and 3 after surgery)
All high-risk patients with cardiac troponin both before and after non cardiac surgery should be screened in order to detect a perioperative heart attack. Cardiac troponin levels should be measured for the following patients:
a. Patients with symptoms or ECG changes suggestive of ischemia or heart attack (2 or 3 serial biomarkers).
b. Patients at high cardiac risk (at 6 to 12 hours, and days 1, 2, and 3 after surgery)
A 12-lead ECG in the perioperative period should be done for the following patients
i. All patients with symptoms of myocardial ischemia
ii. All patients with risk factors for perioperative heart attack (baseline and daily for two, and possibly, three days)
ii. All patients with risk factors for perioperative heart attack (baseline and daily for two, and possibly, three days)
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