Postoperative Myocardial Infarction: Diagnosis and …
[Pages:19]Postoperative Myocardial Infarction: Diagnosis and Management
Todd M. Brown, MD, MSPH Chief Fellow
Division of Cardiovascular Diseases
December 9, 2008
CHEST PAIN
NON-ANGINAL
UNSURE
ANGINAL
STABLE ANGINA UA/NSTEMI
ACS
EKG
STEMI
CE'S
UA
NSTEMI
UA
NSTEMI
STEMI
Adapted from Davies. Heart 2000;83:361
2004 ACC/AHA STEMI Guidelines
Pathophysiology
2007 ACC/AHA UA/NSTEMI Guidelines
Pathophysiology
? Other mechanisms of myocardial ischemia in the postoperative patient
? Fluid mobilization which increases strain on vulnerable myocardium
? Coronary perfusion pressure = DBP ? LVEDP
? Pro-thrombotic state associated with surgery ? Catecholamine surges ? Post-operative pain
? Tachycardia and hypertension
Mauck, et al. Clin Geriatr Med 2008;24:585-605.
Patients at Greatest Risk
? High Risk Clinical Features
? Unstable coronary syndromes
? Unstable or severe angina ? Recent MI
? Decompensated CHF ? Significant arrhythmias ? Severe valvular heart disease
? Other Clinical Risk Factors
? History of ischemic heart disease ? History of CHF ? History of cerebrovascular disease ? Diabetes mellitus ? Renal insufficiency
2007 ACC/AHA Guidelines on Perioperative CV Evaluation and Care for Noncardiac Surgery
Procedural Risk
2007 ACC/AHA Guidelines on Perioperative CV Evaluation and Care for Noncardiac Surgery
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