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Chapter 10 - Postoperative chest pain and shortness of breath

from Section 2 - Cardiology

Published online by Cambridge University Press:  05 September 2013

By
Taki Galanis  and
Geno J. Merli
Edited by
Michael F. Lubin ,
Thomas F. Dodson  and
Neil H. Winawer
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Neil H. Winawer
Affiliation:
Emory University, Atlanta
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Summary

Chest pain and shortness of breath are frequently encountered medical problems in the postoperative period. The differential diagnosis for these symptoms ranges from benign causes to medical emergencies necessitating immediate intervention. In order to accurately identify the etiology of these symptoms, the clinician must rely on a thorough history and physical examination in conjunction with the utilization of appropriate diagnostic tests. This chapter will review the differential diagnosis and evaluation of a patient with postoperative cardiopulmonary symptoms.

Evaluation and risk factor assessment

Potential pulmonary complications that may result in postoperative cardiopulmonary complaints include but are not limited to atelectasis, pneumonia, pleural effusion, pulmonary embolism (PE) and bronchospasm. These morbidities have been found to occur as frequently as cardiac complications in the postoperative period and have been identified as predictors of long-term mortality following surgery [1]. Risk factors for these complications are older age, emergency surgery, underlying chronic lung disease, poor nutritional status and advanced American Society of Anesthesiologists (ASA) class. Certain surgeries, such as those closest to the diaphragm as well as head and neck surgeries, incur a higher risk for postoperative pulmonary complications [1–4]. In addition, smoking appears to affect postoperative outcomes [5]. Table 10.1 includes a more comprehensive list of risk factors for pulmonary complications.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 113 - 118
Publisher: Cambridge University Press
Print publication year: 2013

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