Cardiology>>>>>Assessment for Surgery
Question 8#

A 74-year-old woman undergoes emergency laparotomy after presenting with sepsis and peritonism. In the postoperative period you are asked to review her since she has developed atrial fibrillation and blood tests reveal a raised serum troponin.

Which one of the following is most likely to be the appropriate decision?

A. The troponin elevation is of no significance in the postoperative period in someone who has been so unwell
B. The troponin elevation is related to the atrial fibrillation but is not otherwise significant
C. The troponin elevation indicates a myocardial infarction and she should undergo urgent angioplasty
D. The troponin elevation indicates a worse perioperative prognosis but does not dictate the management
E. The troponin elevation indicates myocardial ischaemia and she should be treated with dual-antiplatelet therapy

Correct Answer is D

Comment:

Troponins T or I are constituents of the myocontractile apparatus and act as sensitive biomarkers for cardiac ischaemia. Levels can be elevated in several clinical scenarios, and this should be seen as indicating a higher risk of morbidity and mortality rather than a diagnostic tool. In the perioperative patient there may be many cardiac and non-cardiac mechanisms for troponin release. Management should be based upon clinical assessment.