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Surgical Management in Patients with Cardiovascular Complications - Pubrica

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SURGICAL MANAGEMENT
IN PATIENTS WITH
CARDIOVASCULAR
COMPLICATIONS:
EXEMPLARY INTRODUCTION SECTION
OF YOUR LITERATURE REVIEW
An Academic presentation by
Dr. Nancy Agens, Head, Technical Operations, Pubrica
Group: www.pubrica.com
Email: [email protected]
Today's Discussion
Outline of Topics
In brief
Introduction
Perioperative Myocardial Infarction Detecting
Perioperative Myocardial Damage
Conclusion
In Brief
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.
As a growing number of elderly patients with known coronary artery
disease (CAD) or with risk factors for CAD are undergoing noncardiac surgery, cardiovascular complications will remain a
significant clinical problem in the future.
Introduction
The number says approximately 100 million adults undergo noncardiac 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.
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.
Detecting Perioperative Myocardial Damage
For detecting perioperative myocardial damage cardiac markers primarily called the
cardiac-specific troponins are vital.
Though, the appropriate cut-off levels for detecting myocardial damage using
troponins 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 coronary
syndrome as well as patients undergoing non-cardiac surgery.
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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