An Academic presentation byDr. Nancy Agens, Head, Technical Operations, Pubrica Group: www.pubrica.comEmail: sales@pubrica.com

SURGICAL MANAGEMENT IN PATIENTS WITH CARDIOVASCULAR COMPLICATIONS:EXEMPLARY INTRODUCTION SECTION OF YOUR LITERATURE REVIEW

In brief

Introduction

Perioperative Myocardial Infarction

Detecting Perioperative Myocardial Damage

Conclusion

Outline of Topics

Today's Discussion

Surgical management of disease has a tremendous impact on our health system. Despite increasingly sophisticated management during the period of a

patient's surgical procedure; cardiovascular complications continue to be major challenges for the clinician.

In Brief

As a growing number of elderly patients with known coronary artery disease (CAD) or with risk factors for CAD are undergoing non- cardiac surgery, cardiovascular complications will remain a significant clinical problem in the future.

The number says approximately 100 million adults undergo non- cardiac surgery worldwide yearly 1 and up to 40% of these patients have or are at risk of coronary artery disease (CAD).

Four million patients per year have been sketched to have a major perioperative cardiovascular complication, including cardiac death, non-fatal myocardial infarction or cardiac arrest.

Introduction

Perioperative Myocardial Infarction

Medical research studies have shown that15-25% 6-9of in-hospital mortality occurs due to perioperative myocardial infarction (PMI).

The absence of primary symptoms in the perioperative period leads to the difficulty to detect PMI may be the major reason for these high mortality rates.

It was reported that hardly only 14% of the patients with a PMI have typical chest pain and consequently 53% of the PMI will not be diagnosed if the physician relies only on symptoms or clinical signs.

For detecting perioperative myocardial damage cardiac markers primarily called thecardiac-specific troponins are vital.

Though, the appropriate cut-off levels for detecting myocardial damage usingtroponins in a surgical setting are debated.

Elevated troponin with or without clinical or ECG signs of ischaemia are known to be associated with poor outcome both in patients with acute coronarysyndrome as well as patients undergoing non-cardiac surgery.

Detecting Perioperative Myocardial Damage

Conclusion

This systematic review will provide information and recommendations based on current guidelines related to perioperative evaluation and

management including perioperative cardiac risk evaluation and assessment of functional capacity, role of ancillary preoperative cardiac evaluation, recommendations related to perioperative medical therapy, perioperative cardiac intervention including management of patients with

prior coronary intervention, perioperative anticoagulant therapy and intraoperative monitoring.

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