Myocardial ischemia post AAA repair
OVERVIEW
- high risk operation and high risk patients
- common complication (4-15%)
- usually occurs in early post operative period (post operative day 3)
- often NSTEMI
- high mortality (17%)
RISK FACTORS
Patient
- IHD
- renal impairment
- previous CVA
- IDDM
Anaesthesia
- intraoperative stability (hypotension, tachycardia, ST changes)
- inhalational better than TIVA (?myocardial precondition)
- ? benefit of regional anaesthesia (decreased surgical stress, increased analgesia)
Surgical
- bleeding/hypovolaemia/anaemia
- cross-clamp time
- emergency procedure
DETECTION
- often silent
- cardiovascular instability: hypotension, arrhythmia, failure
- respiratory: pulmonary oedema, hypoxia
- ECG changes: ST segment, TW, STEMI, NSTEMI, new BBB, arrhythmia
- TNT or I: sensitive and specific (normalises after 10-14 days)
- CK-MB: important in diagnosis of re-infarction (normalises after 3 days)
- PAC: sensitive but not specific
- ECHO: most sensitive and specific, RWMA, diastolic dysfunction, systolic function
Critical Care
Compendium
References and Links
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC
