Surgical Management in Patients with Cardiovascular Complications - Pubrica

1. SURGICALMANAGEMENT IN PATIENTS WITH CARDIOVASCULAR COMPLICATIONS: EXEMPLARY INTRODUCTIONSECTION OF YOUR LITERATUREREVIEW An Academic presentationby Dr. Nancy Agens, Head, Technical Operations, Pubrica Group: www.pubrica.com Email:sales@pubrica.com

2. Today'sDiscussion Outline ofTopics Inbrief Introduction Perioperative Myocardial Infarction Detecting Perioperative Myocardial Damage Conclusion

3. InBrief 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 theclinician.

4. As a growing number of elderly patients with known coronary artery disease (CAD) or with risk factors for CAD are undergoing non- cardiac surgery, cardiovascularcomplications will remain a significant clinical problem in thefuture. Introduction 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 cardiacarrest.

5. Perioperative MyocardialInfarction Medical researchstudies 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 mortalityrates. 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.

6. Detecting Perioperative MyocardialDamage For detecting perioperative myocardial damage cardiac markers primarily calledthe cardiac-specific troponins arevital. Though, the appropriate cut-off levels for detecting myocardial damage using troponins in a surgical setting aredebated. Elevated troponin with or without clinical or ECG signs of ischaemia are known to be associated with poor outcome both in patients with acutecoronary syndrome as well as patients undergoing non-cardiacsurgery.

7. Conclusion This systematic reviewwill 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 intraoperativemonitoring.

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