Myocardial injury after non-cardiac surgery

Myocardial Injury After Non-Cardiac Surgery (MINS) is a significant medical condition that refers to damage to the heart muscle which occurs as a result of undergoing surgery that is not related to the heart. This condition is of paramount importance due to its association with increased morbidity and mortality. MINS is characterized by an elevation in cardiac biomarkers, such as troponin, above the 99th percentile upper reference limit, within 30 days post-surgery. It is crucial to note that MINS can occur in the absence of symptoms or signs of ischemia.

Etiology

The exact cause of MINS is multifactorial and can include direct and indirect factors related to the surgical procedure. Direct factors involve perioperative stress and trauma leading to increased demand on the heart, while indirect factors may include hypoxemia, hypotension, and tachycardia, which can compromise myocardial oxygen supply.

Pathophysiology

The pathophysiology of MINS involves an imbalance between myocardial oxygen supply and demand, leading to myocardial ischemia and subsequent injury. This can be exacerbated by pre-existing conditions such as atherosclerosis or hypertension, which can further impair myocardial oxygen delivery.

Clinical Presentation

MINS often presents without the classic symptoms of myocardial ischemia, such as chest pain or discomfort. Instead, it may be detected incidentally through elevated cardiac biomarkers in the postoperative period. Some patients may experience nonspecific symptoms such as fatigue, dyspnea, or arrhythmias.

Diagnosis

The diagnosis of MINS is primarily based on the detection of elevated cardiac biomarkers, specifically troponin, in the absence of non-ischemic causes. Electrocardiogram (ECG) and imaging studies such as echocardiography may be used to exclude other causes of troponin elevation and to assess for any underlying cardiac conditions.

Management

The management of MINS involves a multidisciplinary approach, including optimization of hemodynamics, correction of any reversible causes, and initiation of secondary prevention measures for cardiovascular disease. This may include antiplatelet therapy, statins, and beta-blockers, depending on the patient's risk factors and underlying conditions.

Prognosis

The prognosis of patients with MINS is variable and depends on the extent of myocardial injury, the presence of underlying cardiovascular disease, and the effectiveness of management strategies. Patients with MINS have a higher risk of major adverse cardiac events (MACE) and mortality compared to those without myocardial injury.

Prevention

Preventive strategies for MINS include preoperative risk assessment and optimization of modifiable risk factors, such as control of hypertension, diabetes, and dyslipidemia. Intraoperative measures to minimize hemodynamic instability and postoperative monitoring for early detection of myocardial injury are also crucial.

‎

---

Translate: - East Asian 中文, 日本, 한국어, South Asian हिन्दी, தமிழ், తెలుగు, Urdu, ಕನ್ನಡ, Southeast Asian Indonesian, Vietnamese, Thai, မြန်မာဘာသာ, বাংলা
European español, Deutsch, français, Greek, português do Brasil, polski, română, русский, Nederlands, norsk, svenska, suomi, Italian
Middle Eastern & African عربى, Turkish, Persian, Hebrew, Afrikaans, isiZulu, Kiswahili,
Other Bulgarian, Hungarian, Czech, Swedish, മലയാളം, मराठी, ਪੰਜਾਬੀ, ગુજરાતી, Portuguese, Ukrainian