Preoperative Cardiac Evaluation

Preoperative Cardiac Evaluation is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

Perioperative cardiac complications are generally defined as cardiac death, MIs (both ST and non-ST elevation), CHF, and clinically significant rhythm disturbances.

Epidemiology

  • Overall, an estimated 50,000 perioperative infarctions and one million other cardiovascular complications occur annually.1 Of those who have a perioperative MI, the risk of in-hospital mortality is estimated at 10%–15%.2
  • Perioperative MI (PMI) is believed to occur via two distinct mechanisms. Type I PMI results from erosion or rupture of unstable atherosclerotic plaque, leading to coronary thrombosis and subsequent myocardial injury. Type II PMI occurs when myocardial oxygen demand exceeds supply in the absence of overt thrombosis.
  • Although angiographic data suggest that existing stenoses may underpin some perioperative events, a significant number of PMIs are “stress” related (Type II) and not because of plaque rupture.3,4
  • Autopsy data indicate that fatal PMIs occur predominantly in patients with multivessel and especially left main coronary artery disease, via the same mechanism as non-PMIs.5

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General Principles

Perioperative cardiac complications are generally defined as cardiac death, MIs (both ST and non-ST elevation), CHF, and clinically significant rhythm disturbances.

Epidemiology

  • Overall, an estimated 50,000 perioperative infarctions and one million other cardiovascular complications occur annually.1 Of those who have a perioperative MI, the risk of in-hospital mortality is estimated at 10%–15%.2
  • Perioperative MI (PMI) is believed to occur via two distinct mechanisms. Type I PMI results from erosion or rupture of unstable atherosclerotic plaque, leading to coronary thrombosis and subsequent myocardial injury. Type II PMI occurs when myocardial oxygen demand exceeds supply in the absence of overt thrombosis.
  • Although angiographic data suggest that existing stenoses may underpin some perioperative events, a significant number of PMIs are “stress” related (Type II) and not because of plaque rupture.3,4
  • Autopsy data indicate that fatal PMIs occur predominantly in patients with multivessel and especially left main coronary artery disease, via the same mechanism as non-PMIs.5

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