Method of visualization of the cardiovascular system during the study of patients with perioperative myocardial injury

Imprint

Seda S. Rashidova. Method of visualization of the cardiovascular system during the study of patients with perioperative myocardial injury. Cardiometry; Special issue No. 25; December 2022; p. 67-69; DOI: 10.18137/cardiometry.2022.25.6769; Available from:

Topicality . Myocardial injury is a common cause for patients seeking emergency medical care, as well as a cause of death in the perioperative period [1]. Prevention of perioperative consequences of myocardial damage has always been one of the most pressing problems in the field of research of patients with cardiovascular diseases.

The aim hereof is to determine an effective technique for imaging the cardiovascular system during the study of patients with perioperative myocardial damage.

Materials and methods . The methodological basis of our research work was a retrospective analysis of patients with myocardial injury in the perioperative period.

Results and Discussions

Myocardial injury has long been considered as a dangerous complication both in surgery and in the postsurgery period. Every year, more than 1 million people who undergo non-cardiac surgery experience cardiovascular complications. Although the number of patients with recorded acute myocardial infarction within 30 days after surgery is small, an increase in the number of patients who experience latent and undetected myocardial damage in surgery and in the post-surgery period is alarming [2].

The most important behavioral risk factors for myocardial injury are unhealthy diet, low physical activity, tobacco use, and alcohol abuse. Exposure to the behavioral risk factors can manifest itself in individuals in form of high blood pressure, high blood glucose level, high blood lipid concentrations, as well as increased BMI values and obesity. These “intermediate risk factors” can be measured in primary care settings and indicate a higher risk of heart attack, stroke, heart failure, and other complications [3].

There is evidence that quitting tobacco use and alcohol abuse, reducing table salt consumption, adhering to a diet high in fruits and vegetables, regular physical activity are capable of lowering risks of cardiovascular diseases [8].

Perioperative myocardial injury (PMI) is a factor in mortality after non-cardiac surgery. Since the vast majority of PMIs are asymptomatic, the PMIs usually remain not detected due to lack of systematic screening in this sort of patients [7].

Among patients aged 45 years and older who have undergone in-hospital non-cardiac surgery, complications in the form of cardiac death, non-fatal myocardial infarction (MI), heart failure or ventricular tachycardia are found in 5% of the cases. Considering the above complications, perioperative MI is the most common incidence.

In addition, there is a large group of patients who have an increase in the troponin concentration, a biomarker of heart damage, but who do not have any symptoms or signs of myocardial ischemia on their electrocardiograms. They are recorded as patients having myocardial injury after non-cardiac surgery when there is no evidence of a non-ischemic etiology (eg, sepsis, pulmonary embolism, rapid atrial fibrillation, chronic elevated troponin level) [6].

The main methods of monitoring/assessment include general examination, auscultation and palpation. They provide important objective and subjective data not available with advanced monitoring methods and can alert you to hidden problems in individual patients.

The examination of the patient can provide information about the adequacy of oxygen supply and carbon dioxide removal, fluid requirements, and the location and alignment of the body structures [4].

Auscultation is used to verify the correct placement of airway devices such as endotracheal intubations and laryngeal masks, to assess blood pressure, and to continuously monitor heart sounds and airflow through the pulmonary system. Palpation can help in assessing the quality of the pulse and the degree of relaxation of the skeletal muscles, as well as in determining the main vascular structures when placing central venous lines or performing regional anesthesia techniques.

For the most effective monitoring of the condition of patients with perioperative myocardial injury, it is necessary to study the patient’s vital signs in more depth [5]. So, the technique should include, in addition to the manipulations listed above, the following:

• 1)    measurement of brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to improve the assessment of the perioperative cardiac risk in patients aged 65 years and over, 68 | Cardiometry | Issue 25. December 2022

as well as in those aged 45-64 years with a significant risk of cardiovascular diseases;

• 2)    in addition to preoperative echocardiography, as well as tomographic angiography at rest, it is necessary to study the same indicators when performing physical exercises or cardiopulmonary exercises in order to increase the effectiveness of assessing the perioperative cardiac risk [9] ;

• 3)    measurement of the daily troponin concentration after surgery in patients with elevated levels of NT-proBNP/BNP;

• 4)    an assessment of changes in the indicators after acetylsalicylic acid and statins treatment in patients with myocarditis.

An accurate assessment of a cardiac risk has several objectives. A reliable assessment of the risks and benefits of surgery may assist in making an informed decision on the appropriateness of surgery. An accurate cardiac risk assessment can also support in proper decision making on further treatment or surgery (e.g., either endovascular or surgical intervention) and informed decisions via monitoring (e.g., troponin measurements) after surgery [10].

Conclusions

Over the past two decades, large-scale clinical trials and observational studies have improved the health professionals’ understanding of the importance of risk predicting and managing, as well as monitoring and managing perioperative cardiac complications.

Despite these advances, cardiac complications after non-cardiac surgery remain a significant problem in the public healthcare. There is a need to continue research to evaluate promising areas for monitoring and imaging of the cardiovascular system in patients with perioperative myocardial injury. Thus, methods should include the use of remote, automated, continuous, non-invasive, hemodynamic and ischemic monitoring to prevent or minimize the risks of developing the disease.