Rapid Clinical Updates: The Latest Hot Topics in Perioperative Medicine-Presentation

Video Transcription

Video Summary

This rapid clinical update session on perioperative medicine, led by Drs. Smita Kalra and Kurt Pfeiffer, focuses on the 2024 AHA/ACC guidelines for perioperative cardiac risk management. Hospitalists play a crucial role in managing increasingly complex surgical patients with multiple comorbidities, requiring thorough preoperative cardiovascular assessment and optimization. Key points include recognizing cardiovascular red flags such as unstable heart failure, severe valvular disease, recent stroke, or recent coronary stenting with timing considerations for surgery.<br /><br />The use of biomarkers, especially BNP/NT-proBNP, offers valuable risk stratification, often outperforming troponins, with BNP testing potentially reducing the need for invasive coronary imaging. Coronary CT angiography is a newer tool but has limitations including availability and false positives; it should be reserved for select cases to identify high-risk coronary anatomy.<br /><br />Postoperative myocardial injury (MINS) is common, often undiagnosed due to asymptomatic presentation, and associated with increased mortality. The guidelines recommend selective troponin surveillance in high-risk patients after elevated-risk surgery, with careful interpretation to differentiate ischemic versus non-ischemic causes. Management involves intensified guideline-directed medical therapy (GDMT) with aspirin and statins showing benefit, while the role of beta blockers and ACE inhibitors is less clear but continuation is generally recommended in stable patients.<br /><br />Overall, the new guidelines provide a framework but emphasize individualized patient assessment, multidisciplinary communication, and thoughtful use of testing to optimize perioperative cardiac outcomes.

Keywords

perioperative medicine

AHA/ACC 2024 guidelines

cardiac risk management

preoperative cardiovascular assessment

BNP/NT-proBNP biomarkers

coronary CT angiography

postoperative myocardial injury (MINS)

troponin surveillance

guideline-directed medical therapy (GDMT)