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Cardiac Imaging: New, Innovative Techniques in Ischemia Detection

K. Shevde,Leon Freudzon,M. Maloney,Richard Feltman

Published 2016 in International Anesthesiology Clinics

ABSTRACT

The aim of this chapter is to explain why it is necessary to go beyond routine angiography and use new and innovative techniques to diagnose myocardial ischemia. Anesthesiologists frequently encounter patients with ischemic heart disease (IHD), which is a source of significant cardiac complications in the perioperative period. In the United States alone, nearly 600,000 people die annually of IHD, accounting for 1 in every 4 deaths. IHD is largely preventable, with many contributing modifiable risk factors such as smoking, diet, obesity, hypertension, sedentary lifestyle, and diabetes mellitus (DM). Perioperative ischemia is common, especially in the postoperative period, with the majority of ischemic episodes presenting as “silent” ischemia. In a study of 1487 male patients over the age of 40 years undergoing noncardiac surgery, it was shown that the incidence of postoperative myocardial infarction was approximately 1% in patients without IHD but it increased >4 times in patients with IHD. Patients with IHD demonstrating signs of ischemia in the perioperative period are more likely to sustain myocardial infarction. DM is an established, independent risk factor for IHD, resulting in more than double the mortality rate found in nondiabetic subjects. The prevalence of DM in the United States has rapidly increased from 4% to 6.3% in the past 20 years, with the result that physicians are seeing

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