Preoperative Evaluation and Management Before Major Noncardiac Surgery

2014 ◽  
pp. 995-1004
Author(s):  
Adam C. Schaffer ◽  
Sylvia C. W. McKean
Keyword(s):  
Cardiac Disease ◽  
Preoperative Evaluation ◽  
The United States ◽  
Noncardiac Surgery ◽  
Elevated Risk ◽  
Cardiac Events ◽  
Medical Clearance ◽  
Estimated Risk ◽  
Preoperative Risk Stratification

There are more than 10 million major noncardiac surgical procedures performed in the United States per year, and this number is expected to grow as the population ages. The problem of perioperative cardiac events among patients undergoing noncardiac surgery is significant. The estimated risk of myocardial infarction (MI) in patients undergoing noncardiac surgery is 1.1% among unselected patients and 3.1% among patients at elevated risk of cardiac disease. The task of the internist providing preoperative evaluation of patients is not to provide medical “clearance.” Instead, the role of the internist is, in addition to answering any specific questions posed by the requesting physician, to provide a thorough assessment of the patient's cardiovascular and other risks for the procedure. This risk assessment can assist in the balancing of risks and benefits that influences whether the surgeon decides to go forward with the procedure. The consulting internist must also provide specific suggestions regarding further testing that may be indicated for preoperative risk stratification and, most importantly, recommendations for measures that can be taken to mitigate the identified risks.

Are the Incidences of Cardiac Events During Noncardiac Surgery in Japan the Same as in the United States and Europe?

2005 ◽  
Vol 100 (5) ◽  
pp. 1236-1240 ◽  
Author(s):  
Makoto Seki ◽  
Satoshi Kashimoto ◽  
Osamu Nagata ◽  
Hitoshi Yoshioka ◽  
Toshihiko Ishiguro ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Noncardiac Surgery ◽  
Cardiac Events

scholarly journals Improving Identification of Patients at Low Risk for Major Cardiac Events After Noncardiac Surgery Using Intraoperative Data

2020 ◽  
Vol 15 (10) ◽  
pp. 581-587
Author(s):  
Amol S Navathe ◽  
Victor J Lei ◽  
Lee A Fleisher ◽  
ThaiBinh Luong ◽  
Xinwei Chen ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Characteristic Curve ◽  
Risk Index ◽  
Model Performance ◽  
The United States ◽  
Noncardiac Surgery ◽  
Low Risk ◽  
Major Adverse Cardiovascular Events ◽  
Cardiac Complications ◽  
Cardiac Events

BACKGROUND/OBJECTIVE: Risk-stratification tools for cardiac complications after noncardiac surgery based on preoperative risk factors are used to inform postoperative management. However, there is limited evidence on whether risk stratification can be improved by incorporating data collected intraoperatively, particularly for low-risk patients. METHODS: We conducted a retrospective cohort study of adults who underwent noncardiac surgery between 2014 and 2018 at four hospitals in the United States. Logistic regression with elastic net selection was used to classify in-hospital major adverse cardiovascular events (MACE) using preoperative and intraoperative data (“perioperative model”). We compared model performance to standard risk stratification tools and professional society guidelines that do not use intraoperative data. RESULTS: Of 72,909 patients, 558 (0.77%) experienced MACE. Those with MACE were older and less likely to be female. The perioperative model demonstrated an area under the receiver operating characteristic curve (AUC) of 0.88 (95% CI, 0.85-0.92). This was higher than the Lee Revised Cardiac Risk Index (RCRI) AUC of 0.79 (95% CI, 0.74-0.84; P < .001 for AUC comparison). There were more MACE complications in the top decile (n = 1,465) of the perioperative model’s predicted risk compared with that of the RCRI model (n = 58 vs 43). Additionally, the perioperative model identified 2,341 of 7,597 (31%) patients as low risk who did not experience MACE but were recommended to receive postoperative biomarker testing by a risk factor–based guideline algorithm. CONCLUSIONS: Addition of intraoperative data to preoperative data improved prediction of cardiovascular complication outcomes after noncardiac surgery and could potentially help reduce unnecessary postoperative testing.

scholarly journals Multimodality Cardiac Imaging in a Patient with Kawasaki Disease and Giant Aneurysms

2016 ◽  
Vol 2016 ◽  
pp. 1-7
Author(s):  
Ranjini Srinivasan ◽  
Rachel Weller ◽  
Anjali Chelliah ◽  
Andrew J. Einstein
Keyword(s):  
Kawasaki Disease ◽  
Cardiac Disease ◽  
Multimodality Imaging ◽  
Adult Population ◽  
Giant Aneurysm ◽  
The United States ◽  
Ivig Treatment ◽  
Serious Illness ◽  
Integral Role

Kawasaki disease is a well-known cause of acquired cardiac disease in the pediatric and adult population, most prevalent in Japan but also seen commonly in the United States. In the era of intravenous immunoglobulin (IVIG) treatment, the morbidity associated with this disease has decreased, but it remains a serious illness. Here we present the case of an adolescent, initially diagnosed with Kawasaki disease as an infant, that progressed to giant aneurysm formation and calcification of the coronary arteries. We review his case and the literature, focusing on the integral role of multimodality imaging in managing Kawasaki disease.

scholarly journals COVID-19 associated cardiac disease: Is there a role of neutrophil extracellular traps in pathogenesis?

2021 ◽  
Vol 8 (4) ◽  
pp. 275-290
Author(s):  
Amal Feiroze Farouk ◽  
◽  
Areez Shafqat ◽  
Shameel Shafqat ◽  
Junaid Kashir ◽  
...  
Keyword(s):  
Cardiac Disease ◽  
Inflammatory Diseases ◽  
Neutrophil Extracellular Traps ◽  
Future Research ◽  
Cardiac Events ◽  
Extracellular Traps ◽  
Adverse Cardiac Events ◽  
New Research ◽  
The Relationship

<abstract> <p>The COVID-19 pandemic has driven an upheaval of new research, providing key insights into the pathogenesis of this disease. Lymphocytopenia, hyper-inflammation and cardiac involvement are prominent features of the disease and have prognostic value. However, the mechanistic links among these phenomena are not well understood. Likewise, some COVID-19 patients exhibit multi-organ failure with diseases affecting the cardiac system, appearing to be an emerging feature of the COVID-19 pandemic. Neutrophil extracellular traps (NETs) have been frequently correlated with larger infarct sizes and can predict major adverse cardiac events. However, the exact mechanism behind this remains unknown. Although the excessive NET formation can drive inflammation, particularly endothelial and promote thrombosis, it is essential to normal immunity. In this paper, we postulate the role of NETs in cardiac disease by providing an overview of the relationship between NET and inflammasome activities in lung and liver diseases, speculating a link between these entities in cardiac diseases as well. Future research is required to specify the role of NETs in COVID-19, since this carries potential therapeutic significance, as inhibition of NETosis could alleviate symptoms of this disease. Knowledge gained from this could serve to inform the assessment and therapeutics of other hyper inflammatory diseases affecting the heart and vasculature alike.</p> </abstract>

Sudden Cardiac Death not Related to Coronary Atherosclerosis

2006 ◽  
Vol 34 (1) ◽  
pp. 52-57 ◽  
Author(s):  
Elena Ladich ◽  
Renu Virmani ◽  
Allen Burke
Keyword(s):  
United States ◽  
Cardiovascular Diseases ◽  
Sudden Cardiac Death ◽  
Cardiac Disease ◽  
Cardiac Death ◽  
Coronary Atherosclerosis ◽  
The United States ◽  
Cardiac Diseases ◽  
Cardiac Events ◽  
Myocardial Diseases

Sudden cardiac death (SCD) accounts for approximately 300,000 cardiac events in the United States each year, representing an overall incidence of 0.1–0.2% per year. Although the vast majority of these may be attributed to coronary atherosclerosis, a wide variety of nonatherosclerotic-related cardiac diseases have been associated with SCD. This review highlights three general categories of cardiac disease not related to atherosclerosis: the cardiomyopathies, inflammatory myocardial diseases, and ion channel disorders. The important role played by genetics in some of these cardiovascular diseases is presented as well as toxic and drug-related etiologies.

scholarly journals Preoperative cardiac risks in noncardiac surgery: The role of coronary angiography

2017 ◽  
Vol 87 (2) ◽  
Author(s):  
Carlo Lombardi ◽  
Marco Sbolli ◽  
Dario Cani ◽  
Garbriele Masini ◽  
Marco Metra ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Preoperative Evaluation ◽  
Myocardial Revascularization ◽  
Disease Diagnosis ◽  
Coronary Arteriography ◽  
Cardiovascular Complications ◽  
Noncardiac Surgery ◽  
Artery Disease

<p>The preoperative  evaluation of  patients candidates  to noncardiac  surgery requires a knowledge  of  factors  related  both to  type of  surgery and  to  features of the  single patient, potentially  responsible  for  perioperative  cardiovascular  complications , fatal and nonfatal. The assessment of   symptoms  and/or noninvasive  testing indicating the  presence of  coronary  artery  disease may  suggest the  need  for  medical therapy  optimization and, eventually, coronary  arteriography  before  the  scheduled timing  of noncardiac  surgery. There is  no evidence  favoring  a prophylactic  myocardial revascularization (percutaneous or  surgical) and more  studies are needed to  define  the role of coronary artery  disease diagnosis and treatment before  high-risk non  cardiac  surgery.</p>

The Role of Gender and Sensation Seeking in Film Choice

2008 ◽  
Vol 20 (3) ◽  
pp. 97-105 ◽  
Author(s):  
Smita C. Banerjee ◽  
Kathryn Greene ◽  
Marina Krcmar ◽  
Zhanna Bagdasarov ◽  
Dovile Ruginyte
Keyword(s):  
United States ◽  
Undergraduate Students ◽  
Sensation Seeking ◽  
Negative Mood ◽  
Positive Mood ◽  
The United States ◽  
High Arousal ◽  
Subject Design ◽  
Happy Mood

This study demonstrates the significance of individual difference factors, particularly gender and sensation seeking, in predicting media choice (examined through hypothetical descriptions of films that participants anticipated they would view). This study used a 2 (Positive mood/negative mood) × 2 (High arousal/low arousal) within-subject design with 544 undergraduate students recruited from a large northeastern university in the United States. Results showed that happy films and high arousal films were preferred over sad films and low-arousal films, respectively. In terms of gender differences, female viewers reported a greater preference than male viewers for happy-mood films. Also, male viewers reported a greater preference for high-arousal films compared to female viewers, and female viewers reported a greater preference for low-arousal films compared to male viewers. Finally, high sensation seekers reported a preference for high-arousal films. Implications for research design and importance of exploring media characteristics are discussed.

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