SHM Converge Scientific Abstract ePoster Gallery-To Order or Not Order Troponin: A Postoperative Dilemma

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This case highlights the dilemma of whether to order postoperative troponins in high-risk surgical patients. A 72-year-old man with multiple cardiovascular risk factors—HTN, diabetes, CKD, obesity, HFrEF, prior tobacco use, and known mild CAD—underwent major orthopedic surgery for a loose femur prosthesis. Although he had no preoperative chest pain or dyspnea, he experienced significant intraoperative stress, including hypotension after induction, prolonged surgery, 2L blood loss, and transfusion of 8 units of blood.<br /><br />On postoperative day 1, he developed nonspecific symptoms such as diaphoresis and nausea/abdominal bloating. Troponin and ECG were ordered because of his elevated cardiac risk. Troponin was markedly elevated, and ECG showed new conduction and ischemic changes. Echocardiography demonstrated reduced LVEF and new wall motion abnormalities. He was treated as a Type 1 MI with aspirin, heparin, and complex PCI to the left main/LAD. Unfortunately, his course was later complicated by VF arrest, shock, multiorgan failure, and death.<br /><br />The presentation emphasizes that postoperative myocardial infarction is often silent or atypical; chest pain occurs in only a minority of cases, while symptoms like dyspnea, nausea, hypotension, and diaphoresis are more common. Myocardial injury after noncardiac surgery (MINS) refers to postoperative troponin elevation from ischemic mechanisms, with or without overt MI, usually within POD 0–3. It is associated with increased 30-day mortality and cardiac arrest risk.<br /><br />Guidelines suggest that postoperative troponin surveillance may be considered in selected high-risk patients, especially when symptoms or hemodynamic instability occur. However, broad screening remains controversial because effective interventions for MINS are not yet clearly established, except when Type 1 MI is present.

Asset Subtitle

Nidhi Rohatgi

Meta Tag

Author List Nidhi Rohatgi

Category Clinical Vignettes

Concept Myocardial Ischemia after Non-Cardiac Surgery

Concept Troponin Monitoring

Concept Postoperative Myocardial Infarction

Concept Troponin Elevation

Concept Postoperative Cardiac Ischemia

Distinguished Non-Finalist

Presenter Organization Stanford University School of Medicine

Presenting Author Nidhi Rohatgi

Track Adult

Keywords

postoperative troponin

myocardial injury after noncardiac surgery

MINS

type 1 myocardial infarction

high-risk surgical patient

orthopedic surgery

troponin surveillance

ischemic ECG changes

left main PCI

postoperative myocardial infarction

Myocardial Ischemia after Non-Cardiac Surgery

Troponin Monitoring

Postoperative Myocardial Infarction

Troponin Elevation

Postoperative Cardiac Ischemia