Detection of perioperative myocardial ischaemia

Abstract

Studies assessing the predictive value of detecting Method of detection Source Dipyridamole thallium Boucher [9] imaging (DTI) Combined clinical data and DTI

Perioperative myocardial ischaemia, heart rate and arrhythmia in patients undergoing thoracotomy: an observational study

“…11 In general suris myocardial ischaemia. 2 It has been shown that the gical populations, heart rate is increased in the postoperative presence of pre-and postoperative myocardial ischaemia in period and this is thought to be detrimental. 12~14 Lending high-risk surgical populations is associated with an adverse support to this theory, a study in general surgical patients cardiac outcome.…”

“…15 operative cardiac morbidity. 2 The aims of this observational study were to determine Studies of perioperative ischaemia have been performed the incidence and severity of perioperative ischaemia, in patient groups with a recognized high incidence of arrhythmia and tachycardia in patients undergoing thoracic ischaemic heart disease, such as those undergoing vascular or thoraco-abdominal surgery and to examine the relationsurgery 4 6 or those with cardiac risk factors undergoing ship between these and adverse operative outcomes, general surgery. 5 In addition, patient populations undergoing transurethral resection of the prostate, 7 hip arthroplasty 8 Patients and methods and lower segment caesarean section 9 have been studied.…”

Can we accurately assess an individual's perioperative risk?

“…This included the use of 12-lead ECG, ambulatory and exercise ECG, echocardiography (static and stress), ventriculography, radio-isotope scanning, and coronary angiography. 5 During the late 1980s and early 1990s, the utility of all of these methods was investigated in 'at risk' populations, often vascular surgery patients. These studies found a scatter of results with some showing a reasonably high correlation between preoperative findings and postoperative events, but others using the same investigation finding a poor predictive relationship.…”

Anaesthetic Assessment and Management of Cardiac Patients for Non‐cardiac Surgery Part I: Assessment

“…A resting 12‐lead ECG is almost always performed in patients suspected of being at risk for cardiac disease, because it is cheap and readily interpretable by a large number of clinicians. Despite this, few prospective studies have investigated its predictive value, and those that have do not provide a clear answer 46 . Coupled with the fact that a normal resting ECG does not exclude cardiac disease, 47 this means a single 12‐lead ECG may not be as useful in preoperative risk assessment as seems initially to be the case.…”

“…Two‐dimensional echocardiography is a most useful tool in the assessment of left ventricular anatomy and function. It provides information about left ventricular mass, wall motion and wall thickness, among other variables 46 . Segmental wall motion abnormalities may be (but are not always) indicative of regional or global ischaemia and these may be used to assess the extent of ‘at‐risk myocardium’.…”