Peri-operative myocardial infarction occurs in 3% of patients undergoing major surgery, while myocardial injury, arrhythmias, and heart failure are also significant causes of postoperative morbidity.
This review summarizes the epidemiology, causation, and management of cardiovascular complications, such as myocardial injury, arrhythmias, and heart failure, following non-cardiac surgery.
Cardiac complications are common after non-cardiac surgery. Peri-operative myocardial infarction occurs in 3% of patients undergoing major surgery. Recently, however, our understanding of the epidemiology of these cardiac events has broadened to include myocardial injury after non-cardiac surgery, diagnosed by an asymptomatic troponin rise, which also carries a poor prognosis. We review the causation of myocardial injury after non-cardiac surgery, with potential for prevention and treatment, based on currently available international guidelines and landmark studies. Postoperative arrhythmias are also a frequent cause of morbidity, with atrial fibrillation and QT-prolongation having specific relevance to the peri-operative period. Postoperative systolic heart failure is rare outside of myocardial infarction or cardiac surgery, but the impact of pre-operative diastolic dysfunction and its ability to cause postoperative heart failure is increasingly recognised. The latest evidence regarding diastolic dysfunction and the impact on non-cardiac surgery are examined to help guide fluid management for the non-cardiac anaesthetist.
Sellers et al. (2018) conducted a review in Cardiovascular complications after non-cardiac surgery. Peri-operative myocardial infarction occurs in 3% of patients undergoing major surgery, while myocardial injury, arrhythmias, and heart failure are also significant causes of postoperative morbidity.