A case is presented that demonstrates heart rate (HR)-related silent myocardial ischemia occurring preoperatively, subsiding intraoperatively, then recurring and leading to a post-operative cardiac death in a patient undergoing peripheral vascular surgery. This case illustrates that patients may have an ischemic threshold for HR whereby recurrent depression of the ST segment may occur during increase of HR to rates as low as 80 to 85 beats per minute (bpm), even in the absence of acute blood pressure (BP) changes. Myocardial ischemia may be HR related; however, the authors are not aware of a case that demonstrates repeated episodes of rate-related ischemia occurring at HRs well below the 100 bpm traditional definition o f tachycardia. The authors conclude that patients at risk for perioperative myocardial ischemia, should be identified and the hemodynamic management of these patients should include control of HR. This implies control of the physiologic variables that influence HR, along with the use of beta-adrenergic blockers. This case also demonstrates the value of Holter monitoring f or ischemia, which, when done preoperatively, can detect patients at risk for unfavorable cardiac outcomes. ischemia monitoring also may be useful during the intraoperative and postoperative periods, a time when ischemia is often silent and undetected. The early recognition o f ischemia would allow for anti-ischemic interventions, which could decrease the morbidity and mortality and patients at risk . for pen operative cardiac complications.
- coronary artery disease
- ischermic heart disease
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine