- 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%)
- renal impairment
- previous CVA
- intraoperative stability (hypotension, tachycardia, ST changes)
- inhalational better than TIVA (?myocardial precondition)
- ? benefit of regional anaesthesia (decreased surgical stress, increased analgesia)
- cross-clamp time
- emergency procedure
- 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
References and Links
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.