Chest pain surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
Common causes of acute [[chest pain]] in the months after [[CABG]] include: | |||
* [[Musculoskeletal]] pain from [[sternotomy]]: the most common cause | |||
* [[Myocardial ischemia]] from acute [[graft stenosis]] or [[occlusion]] | |||
* [[Pericarditis]] | |||
* [[Pulmonary embolism]] | |||
* [[Sternal]] [[wound]] [[infection]] | |||
* Nonunion | |||
* [[Post-sternotomy pain syndrome]] is defined as discomfort after [[thoracic]] [[surgery]], persisting for at least 2 months, and without apparent cause. | |||
* The incidence of [[post-sternotomy pain syndrome]] is varied 7%-66% with a higher [[prevalence]] in [[women]] compared with [[men]] within the first 3 months of [[thoracic surgery]] but, after 3 months, [[postoperative]] [[sex]] difference in [[prevalence]] was not seen. | |||
* Causesa of [[ Graft]] failure within the first year post-[[CABG]] using [[saphenous venous grafts]] are: | |||
*Technical issues | |||
* [[Intimal hyperplasia]] | |||
* [[Thrombosis]] | |||
* [[Internal mammary artery graft]] failure within the first-year post-[[CABG]] is most commonly attributable to issues with the [[anastomotic site]] of the [[graft]]. | |||
*Causes of acute [[chest pain]] several years after [[CABG]] including: | |||
*:[[Graft]] stenosis | |||
*: Occlusion or progression of [[disease]] in a non-bypassed [[vessel]] | |||
* One year after [[CABG]], about 10%-20% of [[saphenous vein grafts]] fail. | |||
* By 10 years, about half of [[saphenous vein grafts]] are patent. | |||
* The [[internal mammary artery]] has patency rates of 90% to 95% 10 to 15 years after [[CABG]]. | |||
* The use of [[radial artery grafts]] for [[CABG]] has a higher patency rate at 5 years of follow-up, compared with the use of [[saphenous vein grafts]]. | |||
* For patients in which [[myocardial infarction]] is suspected, [[angioplasty]] may be indicated. | * For patients in which [[myocardial infarction]] is suspected, [[angioplasty]] may be indicated. | ||
* For patients with [[aortic dissection]]s, emergent surgery may be required.<ref name="pmid15336583">{{cite journal |author=Chun AA, McGee SR |title=Bedside diagnosis of coronary artery disease: a systematic review |journal=Am. J. Med. |volume=117 |issue=5|pages=334–43 |year=2004 |month=September |pmid=15336583 |doi=10.1016/j.amjmed.2004.03.021 |url=}}</ref><ref name="pmid16568192">{{cite journal |author=Ringstrom E, Freedman J |title=Approach to undifferentiated chest pain in the emergency department: a review of recent medical literature and published practice guidelines |journal=Mt. Sinai J. Med. |volume=73 |issue=2|pages=499–505 |year=2006 |month=March |pmid=16568192 |doi= |url=http://www.mssm.edu/msjournal/73/732499.shtml}}</ref><ref name="pmid16500201">{{cite journal |author=Butler KH, Swencki SA |title=Chest pain: a clinical assessment |journal=Radiol. Clin. North Am. |volume=44 |issue=2 |pages=165–79, vii |year=2006 |month=March |pmid=16500201 |doi=10.1016/j.rcl.2005.11.002|url=}}</ref><ref name="pmid16326253">{{cite journal |author=Haro LH, Decker WW, Boie ET, Wright RS |title=Initial approach to the patient who has chest pain |journal=Cardiol Clin |volume=24 |issue=1 |pages=1–17, v |year=2006 |month=February |pmid=16326253|doi=10.1016/j.ccl.2005.09.007 |url=}}</ref><ref name="pmid17080889">{{cite journal |author=Fox M, Forgacs I |title=Unexplained (non-cardiac) chest pain |journal=Clin Med |volume=6 |issue=5 |pages=445–9 |year=2006 |pmid=17080889 |doi=|url=http://openurl.ingenta.com/content/nlm?genre=article&issn=1470-2118&volume=6&issue=5&spage=445&aulast=Fox}}</ref> | * For patients with [[aortic dissection]]s, emergent surgery may be required.<ref name="pmid15336583">{{cite journal |author=Chun AA, McGee SR |title=Bedside diagnosis of coronary artery disease: a systematic review |journal=Am. J. Med. |volume=117 |issue=5|pages=334–43 |year=2004 |month=September |pmid=15336583 |doi=10.1016/j.amjmed.2004.03.021 |url=}}</ref><ref name="pmid16568192">{{cite journal |author=Ringstrom E, Freedman J |title=Approach to undifferentiated chest pain in the emergency department: a review of recent medical literature and published practice guidelines |journal=Mt. Sinai J. Med. |volume=73 |issue=2|pages=499–505 |year=2006 |month=March |pmid=16568192 |doi= |url=http://www.mssm.edu/msjournal/73/732499.shtml}}</ref><ref name="pmid16500201">{{cite journal |author=Butler KH, Swencki SA |title=Chest pain: a clinical assessment |journal=Radiol. Clin. North Am. |volume=44 |issue=2 |pages=165–79, vii |year=2006 |month=March |pmid=16500201 |doi=10.1016/j.rcl.2005.11.002|url=}}</ref><ref name="pmid16326253">{{cite journal |author=Haro LH, Decker WW, Boie ET, Wright RS |title=Initial approach to the patient who has chest pain |journal=Cardiol Clin |volume=24 |issue=1 |pages=1–17, v |year=2006 |month=February |pmid=16326253|doi=10.1016/j.ccl.2005.09.007 |url=}}</ref><ref name="pmid17080889">{{cite journal |author=Fox M, Forgacs I |title=Unexplained (non-cardiac) chest pain |journal=Clin Med |volume=6 |issue=5 |pages=445–9 |year=2006 |pmid=17080889 |doi=|url=http://openurl.ingenta.com/content/nlm?genre=article&issn=1470-2118&volume=6&issue=5&spage=445&aulast=Fox}}</ref> | ||
*Although often fatal, aortic dissection is an indication for urgent surgical therapy. | *Although often fatal, aortic dissection is an indication for urgent surgical therapy. | ||
==References== | ==References== | ||
Revision as of 09:54, 18 January 2022
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aisha Adigun, B.Sc., M.D.[2]
Overview
Surgery may be indicated in the setting of an MI (angioplasty) or in an aortic dissection.
Surgery
Common causes of acute chest pain in the months after CABG include:
- Musculoskeletal pain from sternotomy: the most common cause
- Myocardial ischemia from acute graft stenosis or occlusion
- Pericarditis
- Pulmonary embolism
- Sternal wound infection
- Nonunion
- Post-sternotomy pain syndrome is defined as discomfort after thoracic surgery, persisting for at least 2 months, and without apparent cause.
- The incidence of post-sternotomy pain syndrome is varied 7%-66% with a higher prevalence in women compared with men within the first 3 months of thoracic surgery but, after 3 months, postoperative sex difference in prevalence was not seen.
- Causesa of Graft failure within the first year post-CABG using saphenous venous grafts are:
- Technical issues
- Intimal hyperplasia
- Thrombosis
- Internal mammary artery graft failure within the first-year post-CABG is most commonly attributable to issues with the anastomotic site of the graft.
- Causes of acute chest pain several years after CABG including:
- One year after CABG, about 10%-20% of saphenous vein grafts fail.
- By 10 years, about half of saphenous vein grafts are patent.
- The internal mammary artery has patency rates of 90% to 95% 10 to 15 years after CABG.
- The use of radial artery grafts for CABG has a higher patency rate at 5 years of follow-up, compared with the use of saphenous vein grafts.
- For patients in which myocardial infarction is suspected, angioplasty may be indicated.
- For patients with aortic dissections, emergent surgery may be required.[1][2][3][4][5]
- Although often fatal, aortic dissection is an indication for urgent surgical therapy.
References
- ↑ Chun AA, McGee SR (2004). "Bedside diagnosis of coronary artery disease: a systematic review". Am. J. Med. 117 (5): 334–43. doi:10.1016/j.amjmed.2004.03.021. PMID 15336583. Unknown parameter
|month=ignored (help) - ↑ Ringstrom E, Freedman J (2006). "Approach to undifferentiated chest pain in the emergency department: a review of recent medical literature and published practice guidelines". Mt. Sinai J. Med. 73 (2): 499–505. PMID 16568192. Unknown parameter
|month=ignored (help) - ↑ Butler KH, Swencki SA (2006). "Chest pain: a clinical assessment". Radiol. Clin. North Am. 44 (2): 165–79, vii. doi:10.1016/j.rcl.2005.11.002. PMID 16500201. Unknown parameter
|month=ignored (help) - ↑ Haro LH, Decker WW, Boie ET, Wright RS (2006). "Initial approach to the patient who has chest pain". Cardiol Clin. 24 (1): 1–17, v. doi:10.1016/j.ccl.2005.09.007. PMID 16326253. Unknown parameter
|month=ignored (help) - ↑ Fox M, Forgacs I (2006). "Unexplained (non-cardiac) chest pain". Clin Med. 6 (5): 445–9. PMID 17080889.