Treatment recommendations to prevent myocardial ischemia and infarction in patients undergoing vascular surgery.

Current Treatment Options in Cardiovascular Medicine
Willem-Jan FluDon Poldermans

Abstract

During major vascular surgery (MVS), patients are at high risk for developing unrecognized myocardial infarction (MI) and myocardial ischemia. In reducing postoperative morbidity and mortality, preoperative cardiac risk stratification and adequate medical therapy play a pivotal role. Based on literature and current opinions, medical treatment should comprise at least a combination of beta-blockers, aspirin, and statins. beta-Blockers exert their beneficial effects predominantly through heart rate control, leading to reduced oxygen demand during surgery. A heart rate between 65 and 70 bpm should be achieved. Irrespective of their lipid-lowering effects, statins seem to improve postoperative cardiac outcome by stabilizing coronary artery plaques, thereby preventing atherosclerotic plaque rupture. Aspirin reduces platelet activation and vasoconstriction, thereby limiting ischemic events and reducing nonfatal MI by 34%. Adding clopidogrel to low-dose aspirin might be beneficial toward postoperative cardiac outcomes; however, the effect on the incidence of postoperative bleeding complications may be a problem for future studies to resolve. Whereas beta-blockers inhibit the effect of catecholamines, alpha(2)-agonists inhibit catechol...Continue Reading

References

Jan 1, 1990·Anesthesiology·D T Mangano
May 5, 1994·The New England Journal of Medicine·C Patrono
Nov 14, 1997·Drugs·A J Coukell, A Markham
Feb 19, 1998·The New England Journal of Medicine·J D Parker, J O Parker
Feb 10, 2000·European Heart Journal·J M Cruickshank
Mar 18, 2000·Cardiovascular Pathology : the Official Journal of the Society for Cardiovascular Pathology·M C Cohen, T H Aretz
Apr 20, 2001·JAMA : the Journal of the American Medical Association·E BoersmaUNKNOWN DECREASE Study Group (Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiogrpahy)
Aug 25, 2001·The New England Journal of Medicine·S YusufUNKNOWN Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators
Jan 29, 2003·Circulation·Christopher HeeschenHarvey D White
Aug 23, 2003·Anesthesia and Analgesia·Duminda N Wijeysundera, W Scott Beattie
Sep 11, 2003·European Heart Journal·Guy De BackerUNKNOWN Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice
Dec 31, 2004·The New England Journal of Medicine·Edward O McFallsWilliam G Henderson
Jan 25, 2005·British Journal of Anaesthesia·H-J Priebe
Jul 29, 2005·The New England Journal of Medicine·Peter K LindenauerEvan M Benjamin
Nov 9, 2005·Current Opinion in Lipidology·James K Liao
Dec 21, 2005·Heart·UNKNOWN British Cardiac SocietyUNKNOWN Stroke Association
Jul 11, 2006·Current Opinion in Anaesthesiology·Arthur W Wallace
Aug 8, 2006·Journal of Vascular Surgery·Olaf SchoutenDon Poldermans
Aug 29, 2006·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·S E HoeksD Poldermans
Nov 24, 2006·Anesthesiology·Katja HindlerBernhard Riedel
Feb 27, 2007·Journal of Clinical Anesthesia·Satoshi KashimotoJunzo Takeda
Jul 17, 2007·The American Journal of Cardiology·Olaf SchoutenDon Poldermans

❮ Previous
Next ❯

Citations

Nov 17, 2009·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·H C FluJ H P Lardenoye

❮ Previous
Next ❯

Related Concepts

Related Feeds

Antianginal Drugs: Mechanisms of Action

Antianginal drugs, including nitrates, beta-blockers, and calcium channel blockers, are used in the treatment of angina pectoris. Here is the latest research on their use and their mechanism of action.

Atherosclerosis Disease Progression

Atherosclerosis is the buildup of plaque on artery walls, causing stenosis which can eventually lead to clinically apparent cardiovascular disease. Find the latest research on atherosclerosis disease progression here.