How to reliably detect ischemia in the intensive care unit and operating room.
Detection of myocardial ischemia in the perioperative period is important because it allows for intervention that may prevent progression of ischemia to myocardial infarction. Perioperative ischemia is also an important predictor of adverse cardiovascular outcomes. Patients should first be stratified according to their risk of having cardiovascular disease by identifying major, intermediate, and minor predictors of adverse cardiovascular outcome. Electrocardiographic (ECG) monitoring for ischemia is inexpensive and noninvasive, but may not be applicable to all patients and is not perfectly sensitive or specific. Modern operating room monitors can automate ST segment monitoring and be set to alarm if changes occur. Increases in central venous pressure and pulmonary artery pressure can be caused by myocardial ischemia, but have been shown to be very insensitive compared to ECG. Also, detection of these hemodynamic changes requires insertion of invasive monitoring devices. Transesophageal echocardiography can be used to detect myocardial ischemia by identifying changes in regional wall motion. These transesophageal echocardiography changes occur sooner and more frequently than ECG changes, but require greater knowledge and skill to properly interpret.
Shanewise
Jack S
JS
Division of Cardiothoracic Anesthesiology, Columbia University College of Physicians & Surgeons, New York, NY, USA. jss2128@columbia.edu
D002407:Catheterization, Swan-Ganz; D003331:Coronary Vessels / Q000033:anatomy & histology / Q000473:pathology; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D006801:Humans; D007362:Intensive Care Units; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging; D009873:Operating Rooms