Detection and Significance of Myocardial Ischemia in the Perioperative Period

Abstract

As much as possible must be done to avoid events which reduce oxygen delivery to the myocardium in the perioperative period. This is true for all surgical patients, but becomes of utmost importance in a patient with preexisting coronary artery disease. Recently, it has been shown that organic coronary artery disease is not the only condition which can cause alterations in coronary blood flow. There are undoubtedly cases in which apparently normal arteries have endothelial dysfunctions which can cause modifications in blood flow under clinical conditions which are not uncommon in the perioperative period. Therefore, in addition to intensive intra-and postoperative monitoring of patients with known coronary artery disease, we must underline the importance of attentive preoperative study of high-risk patients who have not yet undergone diagnostic testing. This group includes patients with a family history of coronary artery disease, heavy smokers, and patients with diabetes, dyslipidemias, or hypertension. The need for preoperative study of this class of patients is rendered even more important when the patient has a history of previously unstudied chest pain.