Perioperative MI 

 

 

Signs

 

  • New ST segment or T wave changes

  • New left bundle branch block

  • Arrhythmias, conduction abnormalities

  • Unexplained tachycardia, bradycardia, or hypotension

  • Development of pathological Q waves

  • Regional wall motion abnormalities or new/worse mitral regurgitation on TEE

 

 

Management

 

  • Assess need for airway management & initiation of cardiopulmonary resuscitation

  • Verify ischemia (12 lead ECG or expanded monitor view)

  • Optimize myocardial oxygen supply:

    • ↑ FiO2

    • Treat anemia if present

    • Optimize BP (maintain coronary perfusion pressure) & HR (avoid tachycardia)

  • ↓ coronary oxygen demand:

    • Analgesia 

    • Nitrates (careful in hypotension)

    • Beta blockers (careful in hypotension & acute heart failure)

    • Optimize BP (avoid increased afterload) & HR (avoid tachycardia)

  • Discuss aborting procedure with surgical team

  • Discuss aspirin & anticoagulation with surgical team & cardiology team

  • Send labs: troponin, CBC, ABG

  • Initiate invasive monitoring, consider central venous access

  • Consider TTE/TEE for monitoring volume status & regional wall motion abnormalities

  • If hemodynamically unstable, consider intra-aortic balloon pump

  • Admit to HAU/ICU/CCU