Acute myocardial infarction associated with the induction of general anesthesia

Perioperative acute myocardial infarction (AMI) is the most common cause of postoperative morbidity and mortality. It is a rare but important and fatal complication. Recognizing this situation may be difficult due to the influence of general anesthesia. Early diagnosis and treatment can decrease the morbidity and mortality of this fatal complication. In this case we present a 56-year-old female planned nephrectomy. After induction of general anesthesia acute inferoposterior myocardial infarction occurred and coronary angiograhy showed the proximal portion of the circumflex coronary artery (Cx) was occluded by thrombus, the left anterior descending coronary artery and the right coronary artery were plaque. Percutaneous transluminal coronary angioplasty and the stenting resulted in successful dilatation of the Cx and she was discharged at the fifth day of intervention without any complication.

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  • [1] Landesberg G, Beattie WS, Mosseri M, Jaffe AS, Alpert JS. Perioperative myocardial infarction. Circulation 2009;119:2936-44.
  • [2] Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major non-cardiac surgery. Circulation 1999;100:1043-9.
  • [3] Haagensen R, Steen PA. Perioperative myocardial infarction. Br J Anaesth 1988;61:24-37.
  • [4] Mangano DT. Perioperative cardiac morbidity. Anesthesiology 1990;72:153-84.
  • [5] Breslow MJ, Parker SD, Frank SM, Norris EJ, Yates H, Raff H, et al. Determinants of catecholamine and cortisol responses to lower extremity revascularization. PIRAT Study Group. Anesthesiology 1993;79:1202-9.
  • [6] Chernow B, Alexander HR, Smallridge RC, Thompson WR, Cook D, Beardsley D, et al. Hormonal responses to graded surgical stress. Arch Intern Med 1987;147:1273-8.
  • [7] Frank SM, Higgins MS, Breslow MJ, Fleisher LA, Gorman RB, Sitzmann JV, et al. The catecholamine, cortisol, and hemodynamic responses to mild perioperative hypothermia: a randomized clinical trial. Anesthesiology 1995;82:83-93.
  • [8] Fukumoto Y, Hiro T, Fujii T, Hashimoto G, Fujimura T, Yamada J, et al. Localized elevation of shear stress is related to coronary plaque rupture. J Am Coll Cardiol 2008;51:645-50.
  • [9] Katz RL, Bigger JT. Cardiac arrhythmias during anesthesia and operation. Anesthesiology 1970;33:193-213.
  • [10] Rodrigo MRC, Moles TM, Lee PK. Comparison of the incidence and nature of cardiac arrhythmias occurring dur-ing isoflurane or halothane anesthesia. Studies during dental surgery. Br J Anaesth 1986;58:394-400.
  • [11] Martinez E, Kim L, Rosenfeld B, Faraday N, Bass E, Perler B, et al. Early detection and real-time intervention of postoperative myocardial ischemia: the STOPMI (Study for the Treatment of Perioperative Myocardial Ischemia) Study. Abstract presented at Association of University Anesthesiologists; May 16-18, 2008; Durham, NC.
  • [12] Noordzij PG, Boersma E, Bax JJ, Feringa HH, Schreiner F, Schouten O, et al. Prognostic value of routine preoperative electrocardiography in patients undergoing noncardiac surgery. Am J Cardiol 2006;97:1103-6.
  • [13] Fleisher LA, Nelson AH, Rosenbaum SH. Postoperative myocardial ischemia: etiology of cardiac morbidity or manifestation of underlying disease? J Clin Anesth 1995;7:97-102.
  • [14] Kimura Y, Okuda H. Effects of alpha- and beta-adrenergic antagonists on epinephrine- induced aggregation and intracellular free calcium concentration in human platelets. Biochem Biophys Res Commun 1994;202:1069-75.
  • [15] Wu KK. Platelet activation mechanism and markers in arterial thrombosis. J Int Med 1996;239:17-34.
  • [16] Baldassare D, Mores N, Colli S, Pazzucconi F, Sitori CR, Tremoli E. Platelet alpha2-adrenergic receptors in hypercholesterolemia: relationship between binding studies and epinephrine-induced platelet aggregation. Clin Pharmacol Ther 1997;61:684-91.
  • [17] Alanko J, Riutta A, Mucha I, Kerttula T, Kaukinen S, Vapaatalo H, et al. Adrenaline stimulates thromboxane and inhibits leukotriene synthesis in man. Eicosanoids 1992;5:169-75.