ABSTRACT
INTRODUCTION Despite all efforts at prevention, perioperative myocardial ischemia and myocardial infarction (MI) remain a problem. Conservative estimates suggest that 2% of adults at the age of 50 or older undergoing elective noncardiac surgery have a major perioperative cardiac event (1). The risk is thought to be even higher in patients undergoing urgent or emergency surgery (2). The diagnosis of perioperative ischemia and infarction is not straightforward. Even in the nonoperative setting about 20% of MI presents with symptoms other than chest pain (3). In the operative setting, the majority of ischemic events occur in the first three days after surgery (4,5) when many patients are either on analgesics, or even still intubated and sedated. Therefore, only a small minority of patients present with the typical symptom of chest pain. In the worst-case scenario this means that the diagnosis of MI is completely missed, while in other cases a significant delay in establishing the correct diagnosis is likely (6). The challenges in correctly diagnosing perioperative MI have been discussed in a previous chapter and will not be reiterated at this stage.
