Update 1990 pp 391-404 | Cite as

Diagnosing Myocardial Ischemia in the Operation Room

  • S. Reiz
  • P. Hohner
  • S. Häggmark
Conference paper
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 10)


Myocardial ischemia is a frequently observed in patients with coronary artery disease (CAD) subjected to cardiac or major non-cardiac surgical procedures [1–10]. However, its incidence varies widely (Tables 1, 2). This can be attributed to differences in study populations, study protocols and methods used for detection of ischemia.


Myocardial Ischemia Pulmonary Capillary Wedge Pressure Wall Motion Abnormality Myocardial Lactate Dial Ischemia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Wilkinson PL, Hamilton WK, Moyers JR, et al (1981) Halothane and morphine-nitrous oxide anesthesia in patients under-going coronary artery bypass operations - patterns of intraoperative ischemia. J Thorac Cardiovasc Surg 82:372–378PubMedGoogle Scholar
  2. 2.
    Lieberman RW, Orkin FK, Jobes DR, Schwartz AJ (1983) Hemodynamic predictors of myocardial ischemia during halothane anesthesia for coronary-artery revascularization. Anesthesiology 59:36–41PubMedCrossRefGoogle Scholar
  3. 3.
    Slogoff S, Keats A (1985) Does perioperative myocardial ischemia lead to postoperative myocardial infarction? Anesthesiology 62:107–114PubMedCrossRefGoogle Scholar
  4. 4.
    Slogoff S, Keats A (1986) Further observations on perioperative myocardial ischemia. Anesthesiology 65:539–542PubMedCrossRefGoogle Scholar
  5. 5.
    Coriat P, Harari A, Daloz M, Viars P (1982) Clinical predictors of intraoperative myocardial ischemia in patients with coronary artery disease undergoing non-cardiac surgery. Acta Anesthesiol Scand 26:287–290CrossRefGoogle Scholar
  6. 6.
    Roy WL, Edelist G, Gilbert B (1979) Myocardial ischemia during non-cardiac surgical procedures in patients with coronary-artery disease. Anesthesiology 51:393–397PubMedCrossRefGoogle Scholar
  7. 7.
    Häggmark S, Hohner P, Östman M, et al (1988) Comparison of hemodynamic electrocardiographic, mechanical and metabolic indicators of intraoperative myocardial ischemia in vascular surgical patients with coronary artery disease. Anesthesiology 70:19–25CrossRefGoogle Scholar
  8. 8.
    Knight AA, Hollenberg M, London MJ, et al (1988) Peri-operative myocardial ischemia: importance of the preoperative ischemic pattern. Anesthesiology 68:681–688PubMedCrossRefGoogle Scholar
  9. 9.
    Fegert G, Hollenberg M, Browner W, et al (1988) Peri-operative myocardial ischemia in the noncardiac surgical patient. Anesthesiology 69:A49CrossRefGoogle Scholar
  10. 10.
    Leung JM, O’Kelly B, Browner WS, Tubau J, Hollenberg M, Mangano D, The SPRG (1989) Prognostic importance of postbypass regional wall-motion abnormalities in patients undergoing coronary artery bypass graft surgery. Anesthesiology 71:16–25PubMedCrossRefGoogle Scholar
  11. 11.
    Kugler G (1979) Myocardial release of lactate, inosine and hypoxanthine during atrial pacing and exercise-induced angina. Circulation 59:43–49PubMedGoogle Scholar
  12. 12.
    Soutter WP, Sharp F, Clark DM (1978) Bedside estimation of whole blood lactate. Br J Anaesth 50:445–450PubMedCrossRefGoogle Scholar
  13. 13.
    Blackburn H, Katigbak R (1964) What electrocardiographic leads to take after exercise. Am Heart J 67:184–185PubMedCrossRefGoogle Scholar
  14. 14.
    London MJ, Hollenberg M, Wong MG (1988) Intraoperative myocardial ischemia: localization of continuous 12-lead electrocardiography. Anesthesiology 69:232–241PubMedCrossRefGoogle Scholar
  15. 15.
    Kotrly KJ, Kotter GS, Mortara D, Kampine JP (1984) Intraoperative detection of myocardial ischemia with an ST segment trend monitoring system. Anesth Analg 63:393–397CrossRefGoogle Scholar
  16. 16.
    Ellis JE, Rolzen MF, Aronson S, et al (1988) Comparison of two automated ST-segment analysis systems, EKG (including T wave inversion analysis), and transesophageal echocardiography for the diagnosis of intraoperative myocardial ischemia. Anesthesiology 69:A5Google Scholar
  17. 17.
    Raby KE, Goldman L, Creager MA, et al (1989) Correlation between preoperative ischemia and major cardiac events after peripheral vascular surgery. N Engl J Med 321:1296–1300PubMedCrossRefGoogle Scholar
  18. 18.
    Hollenberg M, Go MJ, Massie BM, Wisneski JA, Gertz EW (1985) Influence of R-wave amplitude on excercise-induced ST depression: need for a “gain factor” correction when interpreting stress electrocardiograms. Am J Cardiol 56:13–17PubMedCrossRefGoogle Scholar
  19. 19.
    Frank E (1956) Accurate, clinically practical system for spatial vectorcardiography. Circulation 13:737PubMedGoogle Scholar
  20. 20.
    Sederholm M, Erhardt L, Sjögren A (1983) Continuous vectorcardiography in acute myocardial infarction. Natural course of ST and QRS vectors. Intern J Cardiology 4:53–63CrossRefGoogle Scholar
  21. 21.
    Häggmark S, Johansson G, Naslund U, Reiz S (1987) Kvantifiering av infarkt och ischämistorlek med kontinuerlig datoriserad vektorcardiografi (VCG). Proceedings of the Swedish Association of Anesthetists: 86/A4Google Scholar
  22. 22.
    Sederholm M, Grottum P, Erhardt L, Kjekshus J (1983) Quantitative assessment of myocardial ischemia and necrosis by continuous vectorcardiography and measurement of creatine kinase release in patients. Circulation 68:1006–1012PubMedCrossRefGoogle Scholar
  23. 23.
    Forrester JS, Wyatt HL, Tyberg JV, et al (1976) Functional significance of regional ischemic contraction abnormalities. Circulation 54:64–70PubMedGoogle Scholar
  24. 24.
    Waters HL, daLuz PL, Wyatt HL, et al (1977) Early changes in regional and global left ventricular function induced by graded reduction in regional coronary perfusion. Am J Cardiol 39:537–543PubMedCrossRefGoogle Scholar
  25. 25.
    Lowenstein E, Foëx P, Francis CM, et al (1981) Regional ischemic ventricular dysfunction in myocardium supplied by a narrowed coronary artery with increasing halothane concentration in the dog. Anesthesiology 55:349–359PubMedCrossRefGoogle Scholar
  26. 26.
    Bellows WH, Bode RH, Levy JH, et al (1984) Noninvasive detection of periinduction ischemic ventricular dysfunction by cardiokymography in humans: preliminary experience. Anesthesiology 60:155–158PubMedCrossRefGoogle Scholar
  27. 27.
    Videcoq M, Arvieux CC, Ramsay JG, et al (1987) The association isoflurane-verapamil causes regional left ventricular dyssynchrony in the dog. Anesthesiology 67:635–641PubMedCrossRefGoogle Scholar
  28. 28.
    Serruyus BN, Hooghoudt TEH, Reiber JHC, et al (1983) Influence of intracoronary nifedipine on left ventricular function, coronary vasomotility, and myocardial oxygen consumption. Br Heart J 49:427–441CrossRefGoogle Scholar
  29. 29.
    Elliott PL, Schauble JF, Weiss J, et al (1980) Echocardiography and LV function during anesthesia. Anesthesiology 53:1980 (53) PS105.CrossRefGoogle Scholar
  30. 30.
    Abel MD, Nishimura RA, Callahan MJ, et al (1987) Evaluation of intraoperative transesophagel two-dimensional echocardiography. Anesthesiology 66:64–68PubMedCrossRefGoogle Scholar
  31. 31.
    Smith JS, Cahalan MK, Benefield DJ, et al (1985) Intra-operative detection of myocardial ischemia in high-risk patients: electrocardiography versus two-dimensional transesophageal echocardiography. Circulation 72:1015–1021PubMedCrossRefGoogle Scholar
  32. 32.
    Diamond GA, Chag M, Vas R, Forrester JS (1978) Cardiokymography: quantitative analysis of regional ischemic left ventricular dysfunction. Am J Cardiol 41:1249–1257PubMedCrossRefGoogle Scholar
  33. 33.
    Vas R, Diamond GAS, Vas R, et al (1979) Assessment of the functional significance of coronary artery disease with atrial pacing and cardiokymography. Am J Cardiol 44:1283–1289PubMedCrossRefGoogle Scholar
  34. 34.
    Silverberg RA, Diamond GA, Vas R, et al (1980) Noninvasive diagnosis of coronary artery disease: the cardiokymographic stress test. Circulation 61:579–589PubMedGoogle Scholar
  35. 35.
    Vas R (1967) Electronic device for physiologic kinetic measurements and detection of extraneous bodies. IEEE Trans Biomed Eng 14:2–10CrossRefGoogle Scholar
  36. 36.
    Vas R, Diamond GA, Wyatt HL (1977) Noninvasive analysis of regional wall motion: cardiokymography. Am J Physiol 233:H700PubMedGoogle Scholar
  37. 37.
    Burke JF, Morganroth J, Soffer J (1984) The cardiokymographic stress test compared to the thallium-201 perfusion exercise test in the diagnosis of coronary artery disease. Am Heart J 107:718–725PubMedCrossRefGoogle Scholar
  38. 38.
    Weiner DA, Principal Investigators (1985) Accuracy of cardiokymography during exercise testing: results of a multicenter study. J Am Coll Cardiol 6:502–509PubMedCrossRefGoogle Scholar
  39. 39.
    Gobel FL, Nordstrom LA, Nelson RR, et al (1978) The rate-pressure product as an index of myocardial oxygen consumption during exercise in patients with angina pectoris. Circulation 57:549–556PubMedGoogle Scholar
  40. 40.
    Moffitt EA, Sethna DH, Gray RJ, et al (1984) Rate-pressure product correlates poorly with myocardial oxygen consumption during anesthesia in coronary patients. Can Anaesth Soc J 31:5–12PubMedCrossRefGoogle Scholar
  41. 41.
    Buffington CW, Bashein G, Sivarajan M (1987) Blood pressure and heart rate predict ischemia in collateral-dependent myocardium. Anesthesiology:A5Google Scholar
  42. 42.
    Kaplan JA, Wells PH (1981) Early diagnosis of myocardial ischemia using the pulmonary artery catheter. Anesth Analg 60:789–793PubMedGoogle Scholar
  43. 43.
    Reiz S, Bálfors E, Sorensen MB, et al (1983) Isoflurane - a powerful coronary vasodilator in patients with coronary artery disease. Anesthesiology 59:91–99PubMedCrossRefGoogle Scholar
  44. 44.
    Lowenstein E, Reiz S (1987) Effects of inhalation anesthetics on systemic hemodynamics and the coronary circulation. In: Kaplan J A (ed) Cardiac anesthesia. Grune and Stratton, New York, pp 3–35Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1990

Authors and Affiliations

  • S. Reiz
  • P. Hohner
  • S. Häggmark

There are no affiliations available

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