Chest pain surgery: Difference between revisions
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* [[Sternal]] [[wound]] [[infection]] | * [[Sternal]] [[wound]] [[infection]] | ||
* Nonunion | * Nonunion | ||
* [[Post-sternotomy pain syndrome]] is defined as discomfort after [[thoracic]] [[surgery]], persisting for at least 2 months, and without apparent cause. | :* [[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. | * 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. | ||
* | * Causes of [[ Graft]] failure within the first year post-[[CABG]] using [[saphenous venous grafts]] are: | ||
*Technical issues | *Technical issues | ||
* [[Intimal hyperplasia]] | * [[Intimal hyperplasia]] | ||
Revision as of 09:56, 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.
- Causes 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 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.