Perioperative MI

A perioperative myocardial infarction is a heart attack occurring during or within a short period after surgery, resulting from an imbalance between the heart's oxygen supply and demand during the physiological stress of the operation.

It can be caused by surgical stress increasing heart workload while blood pressure changes, blood loss or clotting changes during surgery reduce oxygen delivery, particularly in people with pre-existing coronary artery disease.

Symptoms can be subtle or masked by anaesthesia and post-operative pain medication, so it's often detected through routine post-operative heart monitoring or blood tests rather than classic chest pain, especially in the immediate recovery period.

Yes, perioperative MI is a serious complication associated with increased risk of further cardiac events and death, which is why patients at higher cardiac risk are carefully assessed and monitored around the time of surgery.

Risk reduction involves careful pre-operative cardiac risk assessment, optimising any existing heart disease before elective surgery, and careful management of blood pressure, fluid balance and pain during and after the operation.

Treatment follows similar principles to a standard heart attack, including medication to protect the heart and, where appropriate, procedures to open blocked arteries, though timing and choices are carefully balanced against surgical bleeding risk.

Discuss cardiac risk with your surgical team before any major operation if you have known heart disease or risk factors. A private cardiologist can typically provide pre-operative assessment within about one to two weeks to allow time for optimisation before surgery.