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The Patient for Coronary Artery Bypass Surgery

  • Mark J. Badach

Abstract

A 66-year-old white man, obese and a heavy smoker, was scheduled for a coronary artery bypass grafting (CABG) because of severe coronary artery disease (CAD). He presented to the emergency room of his local hospital complaining of sharp substernal chest pain that began shortly after he started shoveling snow from the driveway of his home. He took some nitroglycerin without any improvement. As the pain grew in intensity, he decided to seek medical attention.

Keywords

Coronary Artery Bypass Grafting Pulmonary Capillary Wedge Pressure Coronary Artery Bypass Surgery Coronary Artery Bypass Grafting Surgery Noncardiac Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Mangano D.T.: Assessment of the patient with ischemic heart disease, in Stanley T.H., Sperry R.J. (eds): Anesthesiology and the Heart. Dordrecht, The Netherlands: Kluwer Academic Publishers, 1990, pp 1–11.CrossRefGoogle Scholar
  2. 2.
    Port S., Cobb RR., Coleman R.E., Jones R.H.: Effect of age on the response of the left ventricular function to exercise. N Engl J Med 1980, 303: 1133–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Djokovic J.L., Hedley-Whyte J.: Prediction of outcome of surgery and anesthesia in patients over 80. JAMA 1979, 242: 2301–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Carliner N.H., Fisher M.L., Plotnick G.D., Gabart H., Rapoport A., Kelemen M.H., Moran G.W., Gadacz T., Peters R.W.: Routine preoperative exercise testing in patients undergoing major noncardiac surgery. Am J Cardiol 1985, 56: 51–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Driscoll A.C., Hobika J.H., Etsten B.E., Proger S.: Clinically unrecognized myocardial infarction following surgery. N Engl J Med 1961, 264: 633–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Mohr D.N.: Estimation of surgical risk in the elderly: A correlative review. J Am Geriatr Soc 1983, 31: 99–102.PubMedGoogle Scholar
  7. 7.
    Steen P.A., Tinker J.H., Tarhan S.: Myocardial reinfarction after anesthesia and surgery. JAMA 1978, 239: 2566–70.PubMedCrossRefGoogle Scholar
  8. 8.
    Tarhan S., Moffitt E., Taylor W.F., Giuliani E.R.: Myocardial infarction after general anesthesia. JAMA 1972, 220: 1451–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Plumlee J.E., Boettner R.B.: Myocardial infarction during and following anesthesia and operation. South Med J 1972, 65: 886–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Goldman L.: Cardiac risks and complications of noncardiac surgery. Ann Intern Med 1983, 98: 504–13.PubMedGoogle Scholar
  11. 11.
    Rao T.K., Jacobs K.H., El-Etr A.A.: Reinfarction following anesthesia in patients with myocardial infarction. Anesthesiology 1983, 59: 499–505.PubMedCrossRefGoogle Scholar
  12. 12.
    Diamond G.A., Forrester J.S.: Analysis of probability as an aid in the clinical diagnosis of coronary artery disease. N Engl J Med 1979, 300: 1350–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Sapala J.A., Ponka J.L., Duvernoy W.F.C.: Operative and nonoperative risks in the cardiac patient. J Am Geriatr Soc 1975, 23: 529–34.PubMedGoogle Scholar
  14. 14.
    Goldman L., Caldera D.L., Nussbaum S.R., Southwick F.S., Krogstad D., Murray B., Burke D.S., O’Malley T.A., Goroll A.H., Caplan C.H., Nolan J., Carabello B., Slater E.E.: Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977, 297: 845–50.PubMedCrossRefGoogle Scholar
  15. 15.
    Pasternack P.F., Imparato A.M., Bear G., Baumann F.G., Benjamin D., Sanger J., Kramer E., Wood R.P.: The value of radionuclide angiography as a predictor of perioperative myocardial infarction in patients undergoing abdominal aortic aneurysm resection. J Vasc Surg 1984, 1: 320–5.PubMedGoogle Scholar
  16. 16.
    Mangano D.T.: Biventricular function after myocardial revascularization in humans: Deterioration and recovery patterns during the first 24 hours. Anesthesiology 1985, 62: 571–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Hypertension Detection and Follow-up Program Cooperative Group: Five-year findings of the hypertension detection and follow-up program: I. Reduction in mortality of persons with high blood pressure, including mild hypertension. JAMA 1979, 242: 2562–72.CrossRefGoogle Scholar
  18. 18.
    Roizen M.F.: Anesthetic implications of concurrent diseases. In Miller R.D., (ed): Anesthesia, 3rd ed., New York: Churchill Livingstone, 1990, p 797.Google Scholar
  19. 19.
    Beard O.W., Hipp H.R., Robins M., Verzolini V.R.: Initial myocardial infarction among veterans: Ten-year survival. Am Heart J 1967, 73: 317–21.PubMedCrossRefGoogle Scholar
  20. 20.
    Fein F.S., Sonnenblick E.H.: Diabetic cardiomyopathy. Prog Cardiovasc Dis 1985, 27: 255–70.PubMedCrossRefGoogle Scholar
  21. 21.
    Olson H.G., Lyons K.P., Troope P., Butman S., Piters K.M.: The high-risk acute myocardial infarction patient at 1-year followup: Identification at hospital discharge by ambulatory electrocardiography and radionuclide ventriculography. Am Heart J 1984, 107: 358–66.PubMedCrossRefGoogle Scholar
  22. 22.
    Rooney S.M., Goldiner PL., Muss E.: Relationship of right bundle-branch block and marked left axis deviation to complete heart block during general anesthesia. Anesthesiology 1876, 44: 64–6.CrossRefGoogle Scholar
  23. 23.
    Hertzer N.R.: Myocardial ischemia. Surgery 1983, 93: 97–101.PubMedGoogle Scholar
  24. 24.
    Jensen J., Blankenhorn D.H., Kornerup V.: Coronary disease in familial hypercholesterolemia. Circulation 1967, 36: 77–82.PubMedGoogle Scholar
  25. 25.
    Anderson K.M., Castelli W.P, Levy D.: Cholesterol and mortality: 30 years of follow-up from the Framingham Study. JAMA 1987, 257: 2176–80.PubMedCrossRefGoogle Scholar
  26. 26.
    Stamler J., Wentworth D., Neaton J.D. (for the MRFIT Research Group): Is relationship between serum cholesterol and risk premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenings of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA 1986, 256: 2823.PubMedCrossRefGoogle Scholar
  27. 27.
    Foster E.D., David K.B., Carpenter J.A., Abele S., Fray D.: Risk of non-cardiac operation in patients with defined coronary disease: The Coronary Artery Surgery Study (CASS) Registry Experience. Ann Thorac Surg 1986, 41: 42–50.PubMedCrossRefGoogle Scholar
  28. 28.
    Schoeppel L.S., Wilkinson C, Waters J., Meyers N.S.: Effects of myocardial infarction on perioperative cardiac complications. Anesth Analg 1983, 62: 493–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Wells P., Kaplan J.A.: Optimal management of patients with ischemic heart disease for noncardiac surgery by complementary anesthesiologist and cardiologist interaction. Am Heart J 1981, 102: 1029–37.PubMedCrossRefGoogle Scholar
  30. 30.
    Reul GJ. Jr., Cooley D.A., Duncan J.M., Frazier O.H., Ott D.A., Livesay J.J., Walker W.E.: The effect of coronary bypass on the outcome of peripheral vascular operations in 1,093 patients. J Vase Surg 1986, 3: 788–98.Google Scholar
  31. 31.
    Engelman R.M., Hadji-Rousou I., Breyer R.H., Whittredge P., Harbison W., Chircop R.V.: Rebound vasospasm after coronary revascularization in association with calcium antagonist withdrawal. Ann Thorac Surg 1984, 37: 469–72.PubMedCrossRefGoogle Scholar
  32. 32.
    Goldman L., Caldera D.L., Southwick F.S., Nussbaum S.R., Murray B., O’Malley T.A., Goroll A.H., Caplan C.H., Nolan J., Burke D.S., Krogstad D., Carabello B., Slater E.E.: Cardiac risk factors and complications in non-cardiac surgery. Medicine (Baltimore) 1978, 57: 357–70.PubMedCrossRefGoogle Scholar
  33. 33.
    Deanfield J.E., Maseri A., Selwyn A.P., Chierchia S., Ribeiro P., Krikler S.: Myocardial ischaemia during daily life in patients with stable angina: Its relation to symptoms and heart rate changes. Lancet 1983, 2: 753–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Cohn P.F., Lawson W.E.: Characteristics of silent myocardial ischemia during out-of-hospital activities in asymptomatic angiographically documented coronary-artery disease. Am J Cardiol 1987, 59: 746–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Chierchia S., Lazzari M., Freedman B., Brunelli C, Maseri A.: Impairment of myocardial perfusion and function during painless myocardial ischemia. J Am Coll Cardiol 1983, 1: 924–30.PubMedCrossRefGoogle Scholar
  36. 36.
    Fegert G., Hollenberg M., Browner W., Wellington Y., Levenson L., Franks M., Harris D., Mangano D.: Perioperative myocardial ischemia in the non-cardiac surgical patient (abstract). Anesthesiology 1988, 69: A49.CrossRefGoogle Scholar
  37. 37.
    Raby K.E., Goldman L., Creager M.A., Cook E.F., Weisberg M.C., Whittemore A.D., Selwyn A.P.: Correlation between preoperative ischemia and major cardiac events after peripheral vascular surgery. N Engl J Med 1989, 321: 1296–1300.PubMedCrossRefGoogle Scholar
  38. 38.
    Steward J.B., Khandheria B.K., Oh J.K., Abel M.D., Hughes R.W., Edwards W.D., Nichols B.A., Freeman W.K., Tajik A.J.: Transesophageal echocardiography. Technique, anatomic correlations, implementation, and clinical applications. Mayo Clin Proc 1988, 63: 649–80.Google Scholar
  39. 39.
    Stokely E.M., Buja L.M., Lewis S.E., Parkey R.W., Bonte F.J., Harris R.A. Jr., Willerson J.T.: Measurement of acute myocardial infarcts in dogs with 99 m Tc-stannous pyrophosphate scintigrams. J Nucl Med 1975, 17: 1–5.Google Scholar
  40. 40.
    Holman B.L., Wynne J.: Infarct avid (hot-spot) myocardial scintigraphy. Radiol Clin North Am 1980, 18: 487–99.PubMedGoogle Scholar
  41. 41.
    Cahalan M.K., Litt L., Botvinick E.H., Schiller N.B.: Advances in noninvasive cardiovascular imaging: Implications for the anesthesiologist. Anesthesiology 1987, 66: 356–72.PubMedCrossRefGoogle Scholar
  42. 42.
    Dash H., Massie B.M., Botvinick E.H., Brundage B.H.: The noninvasive identification of left main and three vessel coronary artery disease by myocardial stress perfusion scintigraphy and treadmill exercise electrocardiography. Circulation 1979, 60: 276–84.PubMedGoogle Scholar
  43. 43.
    Gerson M.C., Hurst J.M., Hertzberg VS., Doogan P.A., Cochran M.B., Lim S.P., McCall N., Adolph R.J.: Cardiac prognosis in noncardiac geriatric surgery. Ann Intern Med 1985, 103: 832–7.PubMedGoogle Scholar
  44. 44.
    Eagle K.A., Singer D.E., Brewster D.C., Darling R.C., Mulley A.G., Boucher C.A.: Dipyridomole-thallium scanning in patients, undergoing vascular surgery. JAMA 1987, 257: 2185–9.PubMedCrossRefGoogle Scholar
  45. 45.
    McNamara M.T., Higgins C.B., Schechtmann N., Botvinick E., Lipton M.J., Chatterjee K., Amparo E.G.: Detection and characterization of acute myocardial infarction in man with use of gated magnetic resonance. Circulation 1985, 71: 717–24.PubMedCrossRefGoogle Scholar
  46. 46.
    Wong K.C., Shultz J.R.: Preoperative hypokalemia and the cardiac patient, in Stanley T.H., Sperry RJ. (eds): Anesthesiology and the Heart. Dordrecht, The Netherlands: Kluwer Academic Publishers, 1990, pp 111–8.CrossRefGoogle Scholar
  47. 47.
    Merin R.G., Basch S.: Are the myocardial functional and metabolic effects of isoflurane really different from those of halothane and enflurane? Anesthesiology 1981, 55: 398–408.PubMedCrossRefGoogle Scholar
  48. 48.
    Philbin D.M., Foex P., Drummond G., et al.: Post systolic shortening of canine left ventricle supplied by a stenotic coronary artery when nitrous oxide is added in the presence of narcotics. Anesthesiology 1985, 62: 166.PubMedCrossRefGoogle Scholar
  49. 49.
    Kaplan J.A., Wells PH.: Early diagnosis of myocardial ischemia using the pulmonary arterial catheter. Anesth Analg 1981, 60: 789–93.PubMedGoogle Scholar
  50. 50.
    Bellows W.H., Bode R.H. Jr., Levy J.H., Foex P., Lowenstein E.: Noninvasive detection of peri-induction ischemic ventricular dysfunction by car-diokymography in humans: Preliminary experience. Anesthesiology 1984, 60: 155–8.PubMedCrossRefGoogle Scholar

Copyright information

© Birkhäuser Boston 1991

Authors and Affiliations

  • Mark J. Badach

There are no affiliations available

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