Document Detail


Cardiovascular risk assessment of the diabetic patient undergoing major noncardiac surgery.
MedLine Citation:
PMID:  19520309     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Noncardiac surgery is associated with an increased risk for cardiovascular morbidity and mortality. It is important to stratify the risk of these patients for perioperative cardiac events. Diabetes, a presently rapidly expanding disease, is a major risk factor for cardiovascular morbidity and mortality. Importantly, silent ischemia is more common in diabetic patients than in the general population. When preoperative risk assessment identifies an increased risk, further cardiac testing is warranted. The most commonly used stress tests for detecting cardiac ischemia is treadmill or bicycle ergometry. However, patients undergoing noncardiac surgery frequently have limited exercise capacity due to co-morbidities. Pharmacologic testing, such as dobutamine stress echocardiography and dipyridamole myocardial perfusion scintigraphy can be performed in patients with limited exercise capacity. Non-invasive stress testing should be considered, especially in diabetic patients, to detect asymptomatic coronary artery disease. Furthermore, when an increased cardiac risk is assessed, two strategies could be used to reduce the incidence of perioperative cardiac events: 1) prophylactic coronary revascularization from which the value is still controversial, and 2) pharmacological treatment (with beta-blockers, statins and aspirin), associated with improved post-operative outcome.
Authors:
Sanne Hoeks; Willem-Jan Flu; Jan-Peter van Kuijk; Jeroen Bax; Don Poldermans
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Best practice & research. Clinical endocrinology & metabolism     Volume:  23     ISSN:  1878-1594     ISO Abbreviation:  Best Pract. Res. Clin. Endocrinol. Metab.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-12     Completed Date:  2009-08-27     Revised Date:  2012-11-07    
Medline Journal Info:
Nlm Unique ID:  101120682     Medline TA:  Best Pract Res Clin Endocrinol Metab     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  361-73     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Cardiovascular Diseases / prevention & control
Coronary Artery Disease / diagnosis
Diabetes Mellitus*
Exercise Test
Humans
Perioperative Care
Risk Assessment
Surgical Procedures, Operative / adverse effects*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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