Cardiac risk of noncardiac surgery

Article Abstract:

The stress of any surgery can sometimes precipitate a heart attack if a patient at risk for a cardiac episode is not identified prior to surgery. Atherosclerosis, the build-up of plaque deposits which obstruct the arteries, can cause coronary heart disease when it affects the arteries supplying the heart. Patients with impaired heart function may or may not experience angina, the painful tightening in the chest which is a sign of insufficient supply of blood reaching the heart muscle and which may precede a heart attack. Since it is too costly and dangerous to perform invasive tests on all patients about to undergo noncardiac surgery who do not exhibit symptoms, an uncomplicated and noninvasive method of heart assessment is needed. Many factors should be evaluated before noncardiac surgery is performed. Emergency surgery and any surgery performed on diseased blood vessels has the highest incidence of cardiac complications. The coronary heart disease risk profile should be assessed on all noncardiac patients. Once the risk has been established as high, further laboratory testing should be done. Noninvasive testing methods include: exercise testing; ambulatory electrocardiographic monitoring to measure the electrical activity of the heart muscles; and dipyridamole-thallium imaging, a scanning technique using radioactive material and X-rays to check the coronary arteries. Decisions to continue with the surgery as planned, perform cardiac surgery to repair the abnormal heart vessels, or give drug therapy before surgery, need to be made on a individual basis.

Complications and side effects, Health risk assessment, Blood circulation disorders, Vascular diseases, editorial

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Reducing cardiovascular risk in patients undergoing noncardiac surgery

Article Abstract:

A new treatment may further reduce the cardiovascular risk of patients with heart disease undergoing surgery other than heart surgery. Advances in surgical, anesthetic, and postsurgical care have already greatly reduced the risk. Administering atenolol, a beta-blocker, before, during, and after surgery reduced the long-term risk of cardiac events. Based on this study, patients whose preoperative physical examination reveals heart disease should be considered for treatment. Patients already taking beta-blockers should continue to take them. The value of routinely treating patients free of heart disease is unknown.

Editorial, Analysis, Preoperative care, Cardiac patients, Atenolol

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Lowering cardiac risk in noncardiac surgery

Article Abstract:

All patients with risk factors for a heart attack or unstable angina following general surgery should begin taking a beta blocker several days or several weeks before surgery. Risk factors for a post-operative heart attack include a previous heart attack or history of chest pain, heart failure, and diabetes.

Unstable angina, Adrenergic beta blockers, Adrenergic beta-antagonists, Complications

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