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Evaluation of Non-Cardiac Surgical Patients With Postoperative Troponin Elevation at a Tertiary Referral Hospital
Abstracts
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627 Erysipelothrix Endocarditis: A Case Report and Literature Review M. Vaishnav ∗ , R. Jayasinghe The Gold Coast University Hospital, Southport, Australia Aim: We present a case of Erysipelothrix native aortic valve endocarditis causing decompensated bi- ventricular failure. Case report: A 58-year-old cotton farmer presented with a 13-week history of lethargy, unintentional weight loss, NYHA class 3 dyspnea and orthopnoea. He had type 2 diabetes, hepatitis C and alcohol induced chronic liver disease and hypertension. His dog was the only animal contact. Examination findings: systolic and a loud decrescendo diastolic murmur at the left sternal edge, splinter haemorrhage in the right hand, biventricular failure. He had a normal white cell count and a CRP of 66. Two of his blood culture bottles grew erysipelothrix. An urgent transthoracic echocardiogram showed a 0.9x 0.5 cm lesion on the posterior cusp of the aortic valve causing leaflet disruption and severe aortic regurgitation. He was started on 2.4 g of benzyl penicillin every 4 hours. He re-presented in cardiogenic shock and underwent an aortic valve replacement, aortic root abscess cavity exclusion with a CABG Discussion: Erysipelothrix endocarditis is an uncommon but a potentially fatal form of endocarditis with very few case reports in the literature. Erysipelothrix is a gram positive anaerobic bacillus which can infect farmers, abattoir workers, fish handlers etc. It causes cutaneous lesions, but can also cause endocarditis, osteomyelitis, meningitis and septic arthritis. Endocarditis affects native valves, predominantly aortic. Risk factors for endocarditis include occupational hazard, male sex, immunosuppression, significant alcohol intake or chronic liver disease. Treatment with antibiotics (penicillin, piperacillin, teicoplanin, ciprofloxacin). Valve replacement is common with low recurrence rates. http://dx.doi.org/10.1016/j.hlc.2016.06.629 628 Evaluation of Non-Cardiac Surgical Patients With Postoperative Troponin Elevation at a Tertiary Referral Hospital J. Ha 1,3,∗ , J. Thakkar 2 , C. Chow 1,2,3 1 Westmead
Hospital, Western Sydney Local Health District (WSLHD), Sydney, Australia 2 Cardiovascular Division, The George Institute for Global Health, Sydney, Australia 3 Sydney Medical School, University of Sydney, Sydney, Australia Aim: To investigate the clinical characteristics and outcomes of patients undergoing non-cardiac surgery with postoperative troponin elevation (POTE). Methods: We retrospectively reviewed 169 out of 6084 noncardiac surgical patients admitted from January 2015 to July 2015 who had troponin measured using the hsTnI assay.
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Patients with POTE (defined as troponin above 50ng/L for “high risk” chest pain according to local protocol) were compared with those who did not meet this threshold. Results: 62 of the 169 patients reviewed had a postoperative troponin measured, of which 37 had POTE. 17 patients had a final diagnosis list including perioperative myocardial infarction (PMI), of which 15 had a mean troponin of 762ng/L within 3 days postoperatively. Patients with POTE had a higher mean age (72.1 vs 68.2 years), higher baseline creatinine (155 vs 99 micromol/L) and lower mean perioperative haemoglobin (97 vs 100 g/L) compared to patients without. 7 of 37 patients with POTE required at least 2 units of packed cells periopertively. Of the 17 patients with PMI, 8 were commenced on heparin infusions, 10 were commenced on or continued dual antiplatelet therapy and 2 proceeded to early coronary angiography. Of the 20 patients with POTE but not diagnosed with PMI, 2 had therapeutic anticoagulation and 10 commenced or continued aspirin. 30-day mortality for patients with PMI was substantial (4/17) compared to patients with POTE but not diagnosed with PMI (1/20). Conclusion: POTE in non-cardiac surgical patients is associated with age over 70 years and pre-existing renal impairment. PMI has substantial mortality. http://dx.doi.org/10.1016/j.hlc.2016.06.630 629 Event Monitors for Intermittent Arrhythmias: Real World Experience M. Lim 1,∗ , E. Rubenach 1,2 , L. Alifano 2 , M. McGrady 2 , I. Wilcox 2 , K. Chan 2 1 Royal
Prince Alfred Hospital, Sydney, Australia Sydney Cardiology, Sydney, Australia
2 Central
Background: There are many different devices available to detect intermittent arrhythmias over durations of days to years. Implanted loop recorders have increased the reliability of long-term rhythm monitoring but are relatively expensive compared with event monitors. Methods: We examined the real world performance of a readily available event monitor worn for a maximum of 8 weeks. Patients with known or suspected cardiac arrhythmias were referred by a single group Cardiology practice to a commercial provider. The devices were applied for the maximum duration tolerated by the patient. Rhythm recordings were transmitted by transtelephonic modem to the ECG management system and read by independent Cardiologists blinded to the patients’ clinical information. Results: 118 consecutive patients (51 male, 67 female, mean age 57yrs) were included. The duration of recording varied; the commonest reason to discontinue the recording was due to skin irritation or allergy to the skin electrodes. Significant arrhythmias were detected in 16% of patients including sinus pauses or bradycardia (2), atrial fibrillation or flutter (13), and supraventricular tachycardia (5). The results of the recordings led to treatment changes in 13 patients including antiplatelet, anticoagulant treatment or electrophysiology study with or without ablation. Conclusions: Long-term rhythm monitoring using event monitors results in relatively short periods of rhythm
S270
627 Erysipelothrix Endocarditis: A Case Report and Literature Review M. Vaishnav ∗ , R. Jayasinghe The Gold Coast University Hospital, Southport, Australia Aim: We present a case of Erysipelothrix native aortic valve endocarditis causing decompensated bi- ventricular failure. Case report: A 58-year-old cotton farmer presented with a 13-week history of lethargy, unintentional weight loss, NYHA class 3 dyspnea and orthopnoea. He had type 2 diabetes, hepatitis C and alcohol induced chronic liver disease and hypertension. His dog was the only animal contact. Examination findings: systolic and a loud decrescendo diastolic murmur at the left sternal edge, splinter haemorrhage in the right hand, biventricular failure. He had a normal white cell count and a CRP of 66. Two of his blood culture bottles grew erysipelothrix. An urgent transthoracic echocardiogram showed a 0.9x 0.5 cm lesion on the posterior cusp of the aortic valve causing leaflet disruption and severe aortic regurgitation. He was started on 2.4 g of benzyl penicillin every 4 hours. He re-presented in cardiogenic shock and underwent an aortic valve replacement, aortic root abscess cavity exclusion with a CABG Discussion: Erysipelothrix endocarditis is an uncommon but a potentially fatal form of endocarditis with very few case reports in the literature. Erysipelothrix is a gram positive anaerobic bacillus which can infect farmers, abattoir workers, fish handlers etc. It causes cutaneous lesions, but can also cause endocarditis, osteomyelitis, meningitis and septic arthritis. Endocarditis affects native valves, predominantly aortic. Risk factors for endocarditis include occupational hazard, male sex, immunosuppression, significant alcohol intake or chronic liver disease. Treatment with antibiotics (penicillin, piperacillin, teicoplanin, ciprofloxacin). Valve replacement is common with low recurrence rates. http://dx.doi.org/10.1016/j.hlc.2016.06.629 628 Evaluation of Non-Cardiac Surgical Patients With Postoperative Troponin Elevation at a Tertiary Referral Hospital J. Ha 1,3,∗ , J. Thakkar 2 , C. Chow 1,2,3 1 Westmead
Hospital, Western Sydney Local Health District (WSLHD), Sydney, Australia 2 Cardiovascular Division, The George Institute for Global Health, Sydney, Australia 3 Sydney Medical School, University of Sydney, Sydney, Australia Aim: To investigate the clinical characteristics and outcomes of patients undergoing non-cardiac surgery with postoperative troponin elevation (POTE). Methods: We retrospectively reviewed 169 out of 6084 noncardiac surgical patients admitted from January 2015 to July 2015 who had troponin measured using the hsTnI assay.
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .
Patients with POTE (defined as troponin above 50ng/L for “high risk” chest pain according to local protocol) were compared with those who did not meet this threshold. Results: 62 of the 169 patients reviewed had a postoperative troponin measured, of which 37 had POTE. 17 patients had a final diagnosis list including perioperative myocardial infarction (PMI), of which 15 had a mean troponin of 762ng/L within 3 days postoperatively. Patients with POTE had a higher mean age (72.1 vs 68.2 years), higher baseline creatinine (155 vs 99 micromol/L) and lower mean perioperative haemoglobin (97 vs 100 g/L) compared to patients without. 7 of 37 patients with POTE required at least 2 units of packed cells periopertively. Of the 17 patients with PMI, 8 were commenced on heparin infusions, 10 were commenced on or continued dual antiplatelet therapy and 2 proceeded to early coronary angiography. Of the 20 patients with POTE but not diagnosed with PMI, 2 had therapeutic anticoagulation and 10 commenced or continued aspirin. 30-day mortality for patients with PMI was substantial (4/17) compared to patients with POTE but not diagnosed with PMI (1/20). Conclusion: POTE in non-cardiac surgical patients is associated with age over 70 years and pre-existing renal impairment. PMI has substantial mortality. http://dx.doi.org/10.1016/j.hlc.2016.06.630 629 Event Monitors for Intermittent Arrhythmias: Real World Experience M. Lim 1,∗ , E. Rubenach 1,2 , L. Alifano 2 , M. McGrady 2 , I. Wilcox 2 , K. Chan 2 1 Royal
Prince Alfred Hospital, Sydney, Australia Sydney Cardiology, Sydney, Australia
2 Central
Background: There are many different devices available to detect intermittent arrhythmias over durations of days to years. Implanted loop recorders have increased the reliability of long-term rhythm monitoring but are relatively expensive compared with event monitors. Methods: We examined the real world performance of a readily available event monitor worn for a maximum of 8 weeks. Patients with known or suspected cardiac arrhythmias were referred by a single group Cardiology practice to a commercial provider. The devices were applied for the maximum duration tolerated by the patient. Rhythm recordings were transmitted by transtelephonic modem to the ECG management system and read by independent Cardiologists blinded to the patients’ clinical information. Results: 118 consecutive patients (51 male, 67 female, mean age 57yrs) were included. The duration of recording varied; the commonest reason to discontinue the recording was due to skin irritation or allergy to the skin electrodes. Significant arrhythmias were detected in 16% of patients including sinus pauses or bradycardia (2), atrial fibrillation or flutter (13), and supraventricular tachycardia (5). The results of the recordings led to treatment changes in 13 patients including antiplatelet, anticoagulant treatment or electrophysiology study with or without ablation. Conclusions: Long-term rhythm monitoring using event monitors results in relatively short periods of rhythm