Key result
Continuous ECG monitoring detects asymptomatic preoperative type 2 MI, prompting surgery delay and severe CAD diagnosis.
Why the study?
Perioperative myocardial infarction is a life-threatening complication in major non-cardiac surgeries, and asymptomatic myocardial ischemia can occur in patients with stable coronary artery disease and comorbidities such as diabetes and hypertension.
Case Report (n=1)
No
This case highlights the critical importance of continuous ECG and biomarker monitoring prior to anesthetic induction to detect silent perioperative myocardial infarction in high-risk patients.
Background: Perioperative myocardial infarction (PMI) is a life-threatening complication in major non-cardiac surgeries (NCS) and constitutes the most common cause of postoperative morbidity and mortality. A PMI that is associated with prolonged oxygen supply–demand imbalance and its etiology is defined as a type 2 MI. Asymptomatic myocardial ischemia can occur in patients with stable coronary artery disease (CAD), especially those with comorbidities such as diabetes mellitus (DM), hypertension, or, in some cases, without any risk factors. Case: We report a case of asymptomatic PMI in a 76-year-old patient with underlying hypertension and DM without a previous history of CAD. During the induction of anesthesia, abnormal electrocardiography was discovered, and the surgery was postponed after further studies revealed almost completely occluded three-vessel CAD and type 2 PMI. Conclusions: Anesthesiologists should closely monitor and evaluate the associated cardiovascular risk, including cardiac biomarkers of each patient before surgery, to minimize the possibility of PMI.
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Ki et al. (2023) conducted a case report in Asymptomatic Type 2 Perioperative Myocardial Infarction (n=1). Preoperative continuous ECG and cardiac biomarker monitoring was evaluated. Continuous ECG monitoring detected an asymptomatic type 2 perioperative myocardial infarction before anesthetic induction in a 76-year-old male, leading to postponement of surgery and subsequent diagnosis of severe three-vessel coronary artery disease.
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