Monitoring for myocardial ischemia

During the last 20 years, studies using continuous perioperative electrocardiogram (ECG) monitoring in patients at high risk for postoperative cardiac complications have revolutionized our understanding of the pathophysiology, circumstances, timing and possible prevention of perioperative ischemia and postoperative cardiac morbidity and mortality. The present review attempts to provide a comprehensive and practical summary of the current knowledge on perioperative myocardial ischemia. It starts with a description of the conventional definition of myocardial ischemia on exercise stress-testing and continues with a summary of the findings and insights collected from ambulatory Holter monitoring in non-surgical patients with coronary artery disease. It then recaps the variety of studies using perioperative ischemia monitoring to detail the concepts and controversies brought about by this type of monitoring, and tries to portray a general picture of the association of perioperative ischemia and postoperative cardiac complications—including myocardial infarction—and emphasize the importance of postoperative, not just intraoperative, ischemia monitoring.