SHM Converge Scientific Abstract ePoster Gallery-Post-Operative Monitoring of Patients With Increased Cardiovascular Risk Factors

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This case describes a 70-year-old patient with diabetes, coronary artery disease, heart failure with mildly reduced ejection fraction, and cognitive impairment who was admitted after a fall causing a femoral neck fracture. Preoperative evaluation showed clear lungs, no murmurs, normal renal function, normal troponin-I, and normal sinus rhythm on EKG. A hospitalist consult identified high perioperative cardiac risk by RCRI, but the patient was already on maximal guideline-directed therapy for heart failure and had no indication for PCI or cardiac catheterization.<br /><br />The discussion emphasizes that in patients with baseline cognitive impairment, postoperative delirium can make classic anginal symptoms or equivalents harder to recognize. Current AHA guidance supports surveillance for myocardial injury after non-cardiac surgery (MINS) in selected higher-risk patients, including those with known cardiovascular disease or cardiovascular risk factors undergoing elevated-risk surgery. Specifically, it may be reasonable to measure troponin at baseline and again at 24 and 48 hours after surgery.<br /><br />In this case, postoperative troponin testing would have been appropriate and might have allowed earlier detection of myocardial ischemia. The key teaching point is that MINS is common, occurring in about 20% of non-cardiac surgical patients, and is associated with increased 30-day mortality. Hospitalists should maintain a low threshold to check cardiac enzymes in postoperative patients at increased cardiovascular risk who develop new cardiac or respiratory symptoms, especially when symptoms may be difficult to interpret because of cognitive impairment.<br /><br />The guidelines also note that routine troponin screening is not recommended after low-risk surgery, and management of confirmed MINS may include outpatient cardiovascular risk optimization and, in some cases, consideration of antithrombotic therapy.

Asset Subtitle

Kristen Kipps

Meta Tag

Author List Andrew D. Auerbach, Armond Esmaili, Kristen Kipps, Molly A. Kantor

Category Clinical Vignettes

Concept Postoperative Myocardial Injury

Concept Postoperative Troponin Monitoring

Concept Cardiovascular Disease

Concept Risk Factors

Concept Postoperative Cardiac Ischemia

Distinguished Non-Finalist

Presenter Organization Ucsf

Presenting Author Kristen Kipps

Track Adult

Keywords

myocardial injury after non-cardiac surgery

MINS

postoperative troponin surveillance

perioperative cardiac risk

cognitive impairment

delirium

femoral neck fracture

heart failure

coronary artery disease

AHA guidelines

Postoperative Myocardial Injury

Postoperative Troponin Monitoring

Cardiovascular Disease

Risk Factors

Postoperative Cardiac Ischemia