title: Assessment and management of patients with ischemic heart disease.
abstract: OBJECTIVE
  Review the perioperative management of patients who are scheduled for noncardiac surgery.
  
  
  METHODS
  Review of literature (PubMed, MEDLINE).
  
  
  CONCLUSIONS
  Patients with ischemic heart disease who undergo noncardiac surgery are at significant risk of perioperative cardiac morbidity and mortality. Recent joint guidelines from the American College of Cardiology and American Heart Association have significantly streamlined the preoperative evaluation processes. Augmented hemodynamic control with intensive perioperative pharmacologic therapy with beta-blockers and possibly alpha-2 agonist has been shown to improve perioperative cardiovascular outcomes. However, translating this information to clinical practice continues to be a challenge and requires a multi- disciplinary approach. A particular intraoperative anesthetic technique is unlikely to influence perioperative cardiac morbidity and mortality. Postoperative management with goals of decreasing hemodynamic stress is important in patients with ischemic heart disease. Diagnosis and management of perioperative myocardial infarction continues to be a challenge. However, use of cardiac specific biomarkers should improve the diagnostic process.
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Shamsuddin
authors.initials: S
authors.lastname: Akhtar
authors.forename: David G
authors.initials: DG
authors.lastname: Silverman
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000465:Algorithms; D006801:Humans; D009203:Myocardial Infarction / Q000517:prevention & control; D017202:Myocardial Ischemia / Q000601:surgery*; D010347:Patient Care Planning; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D014336:Troponin / Q000097:blood
chemical_list: D000319:Adrenergic beta-Antagonists; D014336:Troponin