Acute myocardial ischemia or infarction can occur during or after surgery.

The occurrence of myocardial ischemia or infarction may or may not come as a surprise.


Surgery with a known risk for myocardial ischemia or infarction:

(1) procedure on the coronary arteries (PCI, CABG, other)

(2) hypercoagulable state with interruption of anticoagulation


Risk factors:

(1) history of myocardial infarction or peripheral arterial disease

(2) hypertension

(3) diabetes

(4) hyperlipidemia

(5) smoking

(6) obesity

(7) hypercoagulability

(8) vasospasm (Kounis syndrome) due to latex allergy or another trigger

(9) endocrine emergency (pheochromocytoma, other)


The occurrence of myocardial ischemia or infarction may be masked by:

(1) general anesthesia or sedation

(2) failure to monitor the ECG or to notice changes of ischemia or infarction

(3) opioid analgesia


It may be detected by:

(1) ECG changes

(2) rise in serum troponin

(3) patient complaint of chest pain

(4) hypotension or need for vasopressors

(5) onset of cardiogenic shock (rare)

(6) onset of pulmonary edema

(7) increase in the pulse pressure


Echocardiography may show myocardial wall motion abnormalities.

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