Major perioperative cardiac risk factors and postoperative atrial fibrillation
THE CONTEXT
Certain pre-existing cardiac conditions increase the risk of cardiac complications during non-cardiac surgery. Atrial fibrillation is also a common postoperative complication in patients with heart disease.
Major cardiac risk factors
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Recent myocardial infarction within 6 months or unstable angina is a major risk factor.
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Severe coronary artery disease involving the left main stem or three vessels, and severe stable angina on effort, increase risk.
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Severe left ventricular dysfunction and severe valvular heart disease, especially aortic stenosis, are major risk factors.
Postoperative atrial fibrillation
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Hypoxia, myocardial ischaemia or heart failure may trigger postoperative atrial fibrillation.
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The arrhythmia usually terminates spontaneously after its precipitating factors are eliminated.
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Digoxin or β-blockers may be prescribed for heart-rate control when necessary.