[Diagnostic and therapeutic alternatives in perioperative acute myocardial ischemia in heart surgery].
Ischemia and infarct after surgical revascularization are a relatively frequent complication, with high morbidity and mortality. Early diagnosis is essential. However, this is less standardized and more complicated to diagnose than in patients who have not undergone surgery since there is no specific biomarker that allows the clinician to differentiate between myocardial ischemia due to the procedure itself and myocardial damage due to perioperative infarct. Once detected, perioperative ischemia should be treated immediately in order to limit myocardial damage. The objectives of this study have been 1. To show the diagnostic criteria for perioperative infarct and ischemia. 2. to show the different therapeutic options available. 3. to propose a treatment algorithm that includes the differential diagnosis, how to control vasospasm, implantation of balloon counterpulsation, and the possible revascularization strategies (percutaneous coronary intervention vs reoperation).
Bueno-González
A M
AM
Unidad de Postoperatorio Cardiológico, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España. ana_buegon@yahoo.es
Pérez-Vela
J L
JL
Hernández
F
F
Renes
E
E
Arribas
P
P
Corres
M A
MA
Gutiérrez
J
J
Perales
N
N
D000208:Acute Disease; D000465:Algorithms; D015415:Biomarkers; D006348:Cardiac Surgical Procedures; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000175:diagnosis; D015908:Counterpulsation; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000628:therapy*; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D009204:Myocardial Revascularization; D019990:Perioperative Care; D011183:Postoperative Complications / Q000175:diagnosis* / Q000628:therapy*; D011379:Prognosis
D015415:Biomarkers; D002317:Cardiovascular Agents