Document Detail

Multimodal detection of perioperative myocardial ischemia.
MedLine Citation:
PMID:  16429887     Owner:  NLM     Status:  MEDLINE    
Cardiac anesthesiologists have the responsibility to detect myocardial ischemia in a timely manner, which can be a challenging task in the perioperative environment. Transesophageal echocardiography pulmonary artery catheterization, and electrocardiography are the 3 major methods available for monitoring perioperative ischemia. Echocardiography, the newest and most sophisticated method, has been shown to be highly sensitive for detecting ischemia associated with systolic dysfunction. Echocardiography can detect wall-motion abnormalities before electrocardiographic changes develop in patients who are likely to experience supply-mediated ischemia. Perioperative ischemia that occurs after bypass and is detected using transesophageal echocardiography has been found to be related to an adverse outcome. However, the use of echocardiography has some limitations, including the detection of abnormalities not induced by ischemia and the presence of ischemia in areas not visible in the view selected. Pulmonary artery catheterization can provide information about systolic dysfunction, diastolic dysfunction, and mitral regurgitation, but the sensitivity and safety of catheterization have been questioned. Electrocardiography can be a superb monitoring device as long as clinicians pay adequate attention to lead selection and placement, filter selection, and gain adjustment. The optimal monitoring approach should integrate all 3 available monitoring systems in order to increase the likelihood of detecting both supply- and demand-mediated ischemia.
Jonathan B Mark
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital     Volume:  32     ISSN:  0730-2347     ISO Abbreviation:  Tex Heart Inst J     Publication Date:  2005  
Date Detail:
Created Date:  2006-01-24     Completed Date:  2006-03-07     Revised Date:  2013-06-07    
Medline Journal Info:
Nlm Unique ID:  8214622     Medline TA:  Tex Heart Inst J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  461-6     Citation Subset:  IM    
Department of Anesthesiology, Duke University Medical Center, and Anesthesiology Service, Veterans Affairs Medical Center, Durham, North Carolina 27705, USA.
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MeSH Terms
Anesthesiology / methods*
Catheterization, Central Venous
Echocardiography, Transesophageal
Myocardial Ischemia / diagnosis*
Perioperative Care / methods*

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

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