Discussion: Summarize and discuss the clinical characteristics of the condition you have selected and identify the appropriate laboratory, imaging, and other diagnostic and screening tools that apply

Discussion: Summarize and discuss the clinical characteristics of the condition you have selected and identify the appropriate laboratory, imaging, and other diagnostic and screening tools that apply

Discussion: Summarize and discuss the clinical characteristics of the condition you have selected and identify the appropriate laboratory, imaging, and other diagnostic and screening tools that apply

Consider a situation in which an adult-gerontology or acute complex chronic patient exhibits symptoms of cardiovascular abnormalities related to perioperative risk factors. You may not select a condition or disorder that has already been profiled. Respond to the following and support your summary and recommendations plan with a minimum of two APRN-approved scholarly resources.

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Summarize and discuss the clinical characteristics of the condition you have selected and identify the appropriate laboratory, imaging, and other diagnostic and screening tools that apply.

Explain why you selected these tests or tools as being appropriate to the scenario.

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Adult-Gerontology or Acute Complex Chronic Patient 

Cardiovascular peri-operative complications constitute a major cause of postoperative morbidity and mortality in surgical patients. Myocardial ischemia is one of the cardiovascular abnormalities associated with peri-operative risk factors. Myocardial ischemia, with or without subsequent myocardial infarction, is a common and dreaded cardiovascular complication of non-cardiac surgery (Gao et al., 2022). It has an inpatient mortality of 5-17%.and is the most common of the cardiac complications causing postoperative morbidity and mortality. 

Clinical characteristics of myocardial ischemia include the onset of persistent hypotension, with possible nausea and diaphoresis. Patients also have decreased oxygen saturation (Short, 2020). ECG changes include ST-T segment changes or new bundle-branch block and pathologic Q waves. In addition, there is a loss of viable myocardium with new regional wall-motion abnormality (RWMA) and Intracoronary evidence of thrombus on angiography.

Diagnostic tests needed to confirm the diagnosis of Myocardial ischemia include Obtaining a 12-lead ECG; Obtaining baseline and 4-hour troponin levels; Consider transoesophageal or transthoracic echocardiogram if hemodynamic instability is detected Short (2020). A standard 12-lead ECG is valuable and must be obtained.  It helps to identify characteristic ECG changes like new T-wave inversion and ST-segment depression. ST-segment changes can best be seen in leads V3-5, II, and aVF (Gao et al., 2022). According to Short (2020), Increased troponin levels after non-cardiac surgery, even without other features of ischemia independently increases the risk of 30-day mortality. Furthermore, postoperative ECG changes concomitant with a troponin leak are independent predictors of mortality. Transoesophageal Echocardiography (TOE) detects myocardial ischemia by identifying regional wall motion abnormalities.

References

Gao, L., Chen, L., He, J., Wang, B., Liu, C., Wang, R., … & Cheng, R. (2022). Perioperative myocardial injury/infarction after non-cardiac surgery in elderly patients. Frontiers in Cardiovascular Medicine, 9, 910879. https://doi.org/10.3389/fcvm.2022.910879

Short, H. (2020). Perioperative myocardial ischaemia in non-cardiac surgery. Education for anaesthesia providers worldwide, 19.