title: Peri-operative silent myocardial ischaemia in patients undergoing lower limb joint replacement surgery: an indicator of postoperative morbidity or mortality?
abstract: One hundred and twenty-seven patients undergoing major lower limb joint replacement surgery were studied to determine the incidence of silent myocardial ischemia and to ascertain any link between pre-operative cardiac risk factors, silent myocardial ischaemia and postoperative morbidity. Patients underwent ambulatory ECG monitoring for 4 days (on the pre-operative night and for 3 days postoperatively). Postoperative cardiorespiratory symptomatology and morbidity was assessed by questionnaire at 3 months. Eighty-seven patients had risk factors for silent myocardial ischaemia; 42 patients (30 with risk factors) had peri-operative silent myocardial ischaemia. The median ischaemic loads (range) were 1.04 (0.32-13.31) min.h-1 pre-operatively and 5.53 (0.26-56.39), 6.69 (0.04-42.71) and 1.23 (0.1-53.74) min.h-1 on postoperative days 1-3, respectively. Risk factors did not predict the occurrence of silent myocardial ischaemia or an increased ischaemic load pre-operatively or overall postoperatively. New symptoms (chest pain, palpitations, breathlessness or fatigue) were associated with both silent myocardial ischaemia and ischaemic load (p < 0.05). Thus cardiac risk factors do not predict the occurrence of silent myocardial ischaemia or adverse outcome. Peri-operative silent myocardial ischaemia was associated with increased postoperative fatigue.
authors.affiliation: Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Headington, UK.
authors.forename: G W
authors.initials: GW
authors.lastname: French
authors.forename: W H
authors.initials: WH
authors.lastname: Lam
authors.forename: Z
authors.initials: Z
authors.lastname: Rashid
authors.forename: J W
authors.initials: JW
authors.lastname: Sear
authors.forename: P
authors.initials: P
authors.lastname: Foëx
authors.forename: S
authors.initials: S
authors.lastname: Howell
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement; D015716:Electrocardiography, Ambulatory; D005221:Fatigue / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology*; D011183:Postoperative Complications; D012307:Risk Factors; D016896:Treatment Outcome