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Chapter 10 - Postoperative chest pain and shortness of breath

from Section 2 - Cardiology

Published online by Cambridge University Press:  05 September 2013

By
Taki Galanis  and
Geno J. Merli
Edited by
Michael F. Lubin ,
Thomas F. Dodson  and
Neil H. Winawer
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Neil H. Winawer
Affiliation:
Emory University, Atlanta
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Summary

Chest pain and shortness of breath are frequently encountered medical problems in the postoperative period. The differential diagnosis for these symptoms ranges from benign causes to medical emergencies necessitating immediate intervention. In order to accurately identify the etiology of these symptoms, the clinician must rely on a thorough history and physical examination in conjunction with the utilization of appropriate diagnostic tests. This chapter will review the differential diagnosis and evaluation of a patient with postoperative cardiopulmonary symptoms.

Evaluation and risk factor assessment

Potential pulmonary complications that may result in postoperative cardiopulmonary complaints include but are not limited to atelectasis, pneumonia, pleural effusion, pulmonary embolism (PE) and bronchospasm. These morbidities have been found to occur as frequently as cardiac complications in the postoperative period and have been identified as predictors of long-term mortality following surgery [1]. Risk factors for these complications are older age, emergency surgery, underlying chronic lung disease, poor nutritional status and advanced American Society of Anesthesiologists (ASA) class. Certain surgeries, such as those closest to the diaphragm as well as head and neck surgeries, incur a higher risk for postoperative pulmonary complications [1–4]. In addition, smoking appears to affect postoperative outcomes [5]. Table 10.1 includes a more comprehensive list of risk factors for pulmonary complications.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 113 - 118
Publisher: Cambridge University Press
Print publication year: 2013

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References

Smetana, GW, Lawrence, VA, Cornell, JE, American College of Physicians. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med 2006; 144: 581–95.CrossRefGoogle ScholarPubMed
McAlister, FA, Bertsch, K, Man, J, Bradley, J, Jacka, M.Incidence of and risk factors for pulmonary complications after nonthoracic surgery. Am J Respir Crit Care Med 2005; 171: 514–17.CrossRefGoogle ScholarPubMed
Pedersen, T, Eliasen, K, Henriksen, E.A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery: risk indicators of cardiopulmonary morbidity. Acta Anaesthesiol Scand 1990; 34: 144–55.CrossRefGoogle ScholarPubMed
Brooks-Brunn, JA.Predictors of postoperative pulmonary complications following abdominal surgery. Chest 1997; 111: 564–71.CrossRefGoogle ScholarPubMed
Turan, A, Mascha, EJ, Roberman, D et al. Smoking and perioperative outcomes. Anesthesiology 2011; 114: 837–46.CrossRefGoogle ScholarPubMed
Geerts, WH, Bergqvist, D, Pineo, GF et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 2008; 133 (6 Suppl): 381S–453S.CrossRefGoogle Scholar
Younis, LT, Miller, DD, Chaitman, BR.Preoperative strategies to assess cardiac risk before noncardiac surgery. Clin Cardiol 1995; 18: 447–54.CrossRefGoogle ScholarPubMed
Eagle, KA, Coley, CM, Newell, JB et al. Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery. Ann Intern Med 1989; 110: 859–66.CrossRefGoogle ScholarPubMed
Fleisher, LA, Eagle, KA.Clinical practice. Lowering cardiac risk in noncardiac surgery. N Engl J Med 2001; 345: 1677–82.CrossRefGoogle ScholarPubMed
Fleisher, LA, Beckman, JA, Brown, KA et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 2002 guidelines on perioperative cardiovascular evaluation for noncardiac surgery): Developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. Circulation 2007; 116: 1971–96.CrossRefGoogle Scholar
Devereaux, PJ, Xavier, D, Pogue, J et al. Characteristics and short-term prognosis of perioperative myocardial infarction in patients undergoing noncardiac surgery: a cohort study. Ann Intern Med 2011; 154: 523–8.CrossRefGoogle ScholarPubMed
Goldman, L, Caldera, DL, Nussbaum, SR et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977; 297: 845–50.CrossRefGoogle ScholarPubMed
Badner, NH, Knill, RL, Brown, JE, Novick, TV, Gelb, AW.Myocardial infarction after noncardiac surgery. Anesthesiology 1998; 88: 572–8.CrossRefGoogle ScholarPubMed
Ashton, CM, Petersen, NJ, Wray, NP et al. The incidence of perioperative myocardial infarction in men undergoing noncardiac surgery. Ann Intern Med 1993; 118: 504–10.CrossRefGoogle ScholarPubMed
Becker, RC, Underwood, DA.Myocardial infarction in patients undergoing noncardiac surgery. Cleve Clin J Med 1987; 54: 25–8.CrossRefGoogle ScholarPubMed
Anderson, JL, Adams, CD, Antman, EM et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 2002 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol 2007; 50: e1–157.CrossRefGoogle Scholar
Charlson, ME, MacKenzie, CR, Ales, KL et al. The post-operative electrocardiogram and creatine kinase: implications for diagnosis of myocardial infarction after non-cardiac surgery. J Clin Epidemiol 1989; 42: 25–34.CrossRefGoogle ScholarPubMed
Goldhaber, SZ, Visani, L, De Rosa, M.Acute pulmonary embolism: clinical outcomes in the international cooperative pulmonary embolism registry (ICOPER). Lancet 1999; 353 (9162): 1386–9.CrossRefGoogle Scholar
Hirsch, DR, Ingenito, EP, Goldhaber, SZ.Prevalence of deep venous thrombosis among patients in medical intensive care. J Am Med Assoc 1995; 274: 335–7.CrossRefGoogle ScholarPubMed
Stein, PD, Beemath, A, Matta, F et al. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med 2007; 120: 871–9.CrossRefGoogle ScholarPubMed
Desciak, MC, Martin, DE.Perioperative pulmonary embolism: diagnosis and anesthetic management. J Clin Anesth 2011; 23: 153–65.CrossRefGoogle ScholarPubMed
Rodger, MA, Carrier, M, Jones, GN et al. Diagnostic value of arterial blood gas measurement in suspected pulmonary embolism. Am J Respir Crit Care Med 2000; 162: 2105–8.CrossRefGoogle ScholarPubMed
Stein, PD, Terrin, ML, Hales, CA et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest 1991; 100: 598–603.CrossRefGoogle ScholarPubMed
Rodger, M, Makropoulos, D, Turek, M et al. Diagnostic value of the electrocardiogram in suspected pulmonary embolism. Am J Cardiol 2000; 86: 807–9, A10.CrossRefGoogle ScholarPubMed
Panos, RJ, Barish, RA, Whye, DW, Groleau, G.The electrocardiographic manifestations of pulmonary embolism. J Emerg Med 1988; 6: 301–7.CrossRefGoogle ScholarPubMed
Thames, MD, Alpert, JS, Dalen, JE.Syncope in patients with pulmonary embolism. J Am Med Assoc 1977; 238: 2509–11.CrossRefGoogle ScholarPubMed
PIOPED investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). J Am Med Assoc 1990; 263: 2753–9.
Stein, PD, Fowler, SE, Goodman, LR et al. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med 2006; 354: 2317–2327.CrossRefGoogle ScholarPubMed
Anderson, DR, Kahn, SR, Rodger, MA et al. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. J Am Med Assoc 2007; 298: 2743–53.CrossRefGoogle ScholarPubMed

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