الفهرس 
ANATOMY OF THE CORONARY CIRCULATION
Preoperative AssessmentOnly 14 pages are availabe for public view
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Abstract
Perioperative myocardial infarction (PMI) is one of the most important predictors of short- and long-term morbidity and mortality associated with surgery. All patients scheduled to undergo noncardiac surgery should have an assessment of the risk of a cardiovascular perioperative cardiac event mainly by use of stepwise assessment approach. Estimation of perioperative risk by identification of risk factors derived from the history, physical examination, and type of proposed surgery. Also, using either the Revised (Lee) Cardiac Risk Index or the ACS-National Surgical Quality Improvement Program risk prediction rule to establish the patient’s risk. Obtaining a 12-lead ECG in patients with cardiac disease should be considered to have a baseline available to detect postoperative abnormality which confirmed by cardiac biomarkers and further cardiac testing for patients with known or suspected heart disease (echocardiography, stress testing, or 24-hour ambulatory monitoring).
The pathophysiology of PMI have 2 distinct mechanisms (acute coronary syndrome & myocardial oxygen supply-demand imbalance). Myocardial response to ischemia occur in a sequences depends on reperfusion time (reversible,irreversible, stunned myocardium, irritability). Also, the electrophysiology of PMI detected by ECG abnormality help to localization the pattern of myocardial infarction ( transmural, subendocardial, microscopic) and region of MI on myocardial wall. An improved understanding of the pathophysiologic and electrophysiological mechanism of PMIs may facilitate the evaluation and management of preoperative patients and improve their clinical care.
Appropriate perioperative management strategies can reduce cardiovascular risk. Coronary artery revascularization include either CABG or PCI with or without stenting can be proper management strategy for patients at hight risk cardiac events. Perioperative medical therapy can prevent perioperative cardiac events by use of beta-blocker, statins, antiplatelet, anticoagulants, alpha-2 agonist, calcium channel blocker and ACEIs. The indications and contraindications of these medication should be considered according to patients evaluation. Most of arrhythmias and conduct disorder occur in the postoperative setting must be managed and followed. Also, anesthetic cosiderations should be taken to prevent intraoperative cardiac events