Anaesthesia of a patient with CHD

The most frequent cause of death in the Czech republic and one of the most common diagnoses in our population is coronary heart disease. We are therefore looking at a significant patient population, and it is likely that some of these may present with comorbidities that will need to be treated surgically with consideration of their diagnosis of this disease. The solver will be led through each step of the anaesthesia and perioperative management of the patient with coronary heart disease by a detailed algorithm. This algorithm is also focused on some of the situations that could occur during surgery and their management.

coronary heart disease
myocardial infarction
angina pectoris
Published at: 1.6.2023


Jana Polášková, MD
Physician, Department of Anesthesiology, Resuscitation and Intensive Care, 2nd Faculty of Medicine Charles University, University Hospital Motol, Prague, Czech Republic

I admire you for creating such a beautifully designed and practical algorithm. I sometimes think that in our anaesthetic practise, we all focus far too much on the patients with unusual diseases and don't see regular patients nearly as much. Certainly, the patient with coronary artery disease belongs in our anaesthesia routine. To see such a patient, we do not need to work in a specialised department. This algorithm is therefore useful for everyone.


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Learning targets

The student can identify a patient at risk of cardiaovascular event during anaesthesia.
The student is able to select appropriate perioperative monitoring of a patient with CHD.
The student knows the proper method of anesthesia management for the patient with CHD.
The student knows how to select adequate diagnostic techniques when peroperative MI is suspected.

Key points

Patients with CHD have an increased risk of developing perioperative MI, so it is advisable to continue established CHD therapy.
The preferred agent for induction of anaesthesia is etomidate.
Tachycardia and blood pressure fluctuations should be avoided during anaesthesia.
To diagnose AIM, it is necessary to know the dynamics of cardiac markers and to perform 12-lead ECG.

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