Chest pain surgery: Difference between revisions

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{{Chest pain}}
{{Chest pain}}
{{CMG}}{{AE}}{{Aisha}}
{{CMG}}{{AE}} {{Sara.Zand}} {{Aisha}}
==Overview==
==Overview==
Surgery may be indicated in the setting of an MI ([[angioplasty]]) or in an [[aortic dissection]].
Common  causes  of  acute  [[chest pain]]  in the months after [[CABG]] include [[musculoskeletal]]  pain  from  [[sternotomy]], [[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]] are using [[saphenous venous grafts]], [[intimal  hyperplasia]], [[thrombosis]]. [[Internal mammary artery graft]] failure within the first-year post-[[CABG]] is most commonly cause asscociated with the [[anastomotic site]] of the [[graft]]. Causes of acute [[chest pain]]  several  years  after  [[CABG]] include [[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 patency  rates  of [[internal  mammary  artery]] is 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]].


==Surgery==
==Surgery==
* For patients in which [[myocardial infarction]] is suspected, [[angioplasty]] may be indicated.
Common  causes  of  acute  [[chest pain]] in  the  months after [[CABG]] include:<ref name="pmid34709879">{{cite journal |vauthors=Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ |title=2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines |journal=Circulation |volume=144 |issue=22 |pages=e368–e454 |date=November 2021 |pmid=34709879 |doi=10.1161/CIR.0000000000001029 |url=}}</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>
* [[Musculoskeletal]]  pain  from  [[sternotomy]]:  the  most  common cause
*Although often fatal, aortic dissection is an indication for urgent surgical therapy.
* [[Myocardial  ischemia]]  from  acute  [[graft  stenosis]]  or  [[occlusion]]
 
* [[Pericarditis]]
==Overview==
* [[Pulmonary embolism]]
Surgical intervention is not recommended for the management of [disease name].
* [[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 associated 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]].


OR


Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]


 
* For [[patients]] with [[aortic dissection]]s, emergent surgery may be required
OR
*Although often fatal, aortic dissection is an indication for urgent surgical therapy.
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
 
OR
 
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
 
OR
 
Surgery is the mainstay of treatment for [disease or malignancy].
 
==Indications==
 
*Surgical intervention is not recommended for the management of [disease name].
OR
*Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either:
**[Indication 1]
**[Indication 2]
**[Indication 3]
*The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either:
**[Indication 1]
**[Indication 2]  
**[Indication 3]
 
==Surgery==
 
*The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
OR
*Surgery is the mainstay of treatment for [disease or malignancy].
 
==Contraindications==


==References==
==References==

Latest revision as of 13:25, 12 March 2022

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Aisha Adigun, B.Sc., M.D.[3]

Overview

Common causes of acute chest pain in the months after CABG include musculoskeletal pain from sternotomy, 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 are using saphenous venous grafts, intimal hyperplasia, thrombosis. Internal mammary artery graft failure within the first-year post-CABG is most commonly cause asscociated with the anastomotic site of the graft. Causes of acute chest pain several years after CABG include 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 patency rates of internal mammary artery is 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.

Surgery

Common causes of acute chest pain in the months after CABG include:[1]


  • For patients with aortic dissections, emergent surgery may be required
  • Although often fatal, aortic dissection is an indication for urgent surgical therapy.

References

  1. ↑ Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ (November 2021). "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 144 (22): e368–e454. doi:10.1161/CIR.0000000000001029. PMID 34709879 Check |pmid= value (help).
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