Cardiac Management in the ICU

• Published in: Chest Vol. 115; no. 5; pp. 138S - 144S
• Main Author: Ramsay, James G.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.05.1999; American College of Chest Physicians
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arrhythmias, Cardiac - drug therapy; Biological and medical sciences; Cardiac function; Cardiovascular disease; Catheters; Coronary Disease - therapy; Coronary vessels; Critical Care; Disease prevention; Drugs; Electrolytes; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Enzymes; Epidural; Heart failure; Heart Failure - therapy; Humans; Hypertension; Hypertension - drug therapy; Intensive care medicine; Intensive Care Units; Ischemia; Medical sciences; Myocardial Ischemia - therapy; Patients; Postoperative Care; Postoperative period; Pulmonary arteries; Respiration, Artificial; Surgery; Surgical Procedures, Operative; Vein & artery diseases; Human; Hypertension; Heart failure; Postoperative; Arrhythmia; Cardiovascular disease; Coronary heart disease; Myocardial disease; Intensive care unit; Vascular disease; Prevention; Clinical management; Treatment; Ischemia; Heart disease; Surgery; Myocardium; Complication; Diagnosis
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.115.suppl_2.138S

Coronary artery disease (CAD) is common in the surgical population, with up to 50% of postoperative deaths due to cardiac events. Most of these events are ischemic, with some being exacerbations of underlying congestive heart failure (CHF). Recent data indicate that acute perioperative β-adrenergic blockade can reduce ischemia and ischemic events. Postoperative monitoring should focus on myocardial ischemia, with preparation for rapid treatment using IV therapy. A few studies suggest that elderly patients with known CAD undergoing major procedures might benefit from perioperative treatment guided by information from a pulmonary artery catheter. Postoperative CHF, which is likely to present early after surgery, may need aggressive management with diuretics, vasodilators, and inotropic drugs. Mechanical ventilation should be considered. When the patient develops severe or refractory dysrhythmias, serum magnesium levels should be supplemented and consideration given to IV use of amiodarone. Postoperative hypertension is common and can precipitate ischemia, CHF, and arrhythmias as well as cause bleeding. Newer IV drugs are arterial specific and can lower BP in a smooth and predictable manner. All acute cardiac disorders can be precipitated or exacerbated by inadequate pain control, hypoxemia, and fluid or electrolyte disorders.