DOI: https://doi.org/10.14710/jai.v0i0.68386

Myocardial Injury after Noncardiac Surgery: A Case Report of Acute Chest Pain and Elevated Troponin Levels, Challenges and Management Strategies

1Faculty of Medicine, Universitas Riau/Arifin Achmad Regional Hospital, Pekanbaru, Indonesia

2Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Riau/ Arifin Achmad Regional Hospital, Pekanbaru, Indonesia

Received: 23 Nov 2024; Revised: 10 Feb 2025; Accepted: 25 Jun 2025; Available online: 30 Jun 2025.
Open Access Copyright 2021 JAI (Jurnal Anestesiologi Indonesia)
Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.

Citation Format:
Cover Image
Abstract

Background: Perioperative myocardial injury is a common complication following noncardiac surgery, linked to significant morbidity and mortality. With over 300 million surgeries performed worldwide annually, this number has increased by more than 100 million in the past two decades.

Case: A 42-year-old woman underwent elective craniotomy for a right cerebellar hemangioblastoma and was admitted to the ICU postoperatively. On day three, she developed typical chest pain, inferior ST-elevation myocardial infarction (STEMI), and cardiogenic shock. Her medical history included the use of euthyrox following a total thyroidectomy 15 years prior, with no prior cardiac issues. Upon examination, she was conscious but had low blood pressure (58/41 mmHg), an elevated heart rate (103 bpm), and cold extremities. Her troponin I level was elevated at 9383.0 ng/mL. The diagnosis was major postoperative myocardial infarction.

Therapy: The patient received aspirin, atorvastatin, heparin, norepinephrine, and dobutamine for shock management, with close hemodynamic monitoring. By day six, her condition improved, and her electrocardiogram (ECG) was normal. By day nine, she was transferred to the high care unit.

Discussion: Myocardial injury after noncardiac surgery (MINS) includes both myocardial infarction and ischemic myocardial injury, which may not meet the Universal Definition of Myocardial Infarction. MINS usually occurs within 30 days of surgery, especially within the first 72 hours. Its causes are multifactorial, including plaque rupture, oxygen supply-demand imbalance, arrhythmias, and pulmonary embolism. Studies suggest that cardiovascular therapy, including aspirin and statins, is effective. Aspirin reduces 30-day mortality, while statins offer long-term benefits through anti-inflammatory effects. Low-dose aspirin, statins, and Renin-Angiotensin System inhibitors are recommended.

Conclusion: MINS is a serious postoperative complication, even in patients without a history of cardiovascular disease, as demonstrated in this case. Prompt recognition and appropriate therapy with aspirin, heparin, and statins, along with close monitoring, can lead to significant clinical improvement.

Note: This article has supplementary file(s).

Fulltext View|Download |  common.other
Copyright Transfer Agreement
Subject
Type Other
  Download (820KB)    Indexing metadata
Keywords: chest pain; MINS; myocardial infarction; myocardial injury; STEMI

Article Metrics:

Article Info
Section: Case Reports
Language : EN
Recent articles
Comparison Between the Use of 10% Lidocaine Spray on the Mole Palate, Posterior Pharynx, Tonsillar Pillar, Hypopharynx, and Endotracheal Tube on Hemodynamics and Post-Intubation Throat Pain Effect of Coloading Ringer Lactate on Blood Pressure Stability in Patients with Spinal Anesthesia Comparison of Neck Circumference to Thyromental Distance as A Predictor of Difficulty Visualizing The Larynx in Elective Surgery Patients At Haji Adam Malik General Hospital Successful High-Risk Pulseless-Balloon Aortic Valvuloplasty Procedure in Uncorrected Pulmonary Atresia with Severe Congenital Aortic Stenosis and Low Left Ventricular Function Fascia Iliaca Compartment Block as Pain Management for Postoperative Femur Fracture in the Elderly: A Case Report Myocardial Injury after Noncardiac Surgery: A Case Report of Acute Chest Pain and Elevated Troponin Levels, Challenges and Management Strategies More recent articles
Most cited articles
Patofisiologi Penyakit Jantung Koroner Midazolam Intravena Dosis Rendah Tidak Mempengaruhi Nitric Oxide Intraperitoneal Mencit Balb/C Yang Terpapar Lipopolisakarida More cited articles
  1. Nepogodiev D, Martin J, Biccard B, Makupe A, Bhangu A, Nepogodiev D, et al. Global burden of postoperative death. The Lancet. 2019 Feb;393(10170):401
  2. Weiser TG, Haynes AB, Molina G, Lipsitz SR, Esquivel MM, Uribe-Leitz T, et al. Size and distribution of the global volume of surgery in 2012. Bull World Health Organ. 2016 Mar 1;94(3):201-209F
  3. Meara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, Ameh EA, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet. 2015 Aug;386(9993):569–624
  4. Smilowitz NR, Gupta N, Ramakrishna H, Guo Y, Berger JS, Bangalore S. Perioperative Major Adverse Cardiovascular and Cerebrovascular Events Associated With Noncardiac Surgery. JAMA Cardiol. 2017 Feb 1;2(2):181
  5. Smilowitz NR, Gupta N, Guo Y, Berger JS, Bangalore S. Perioperative acute myocardial infarction associated with non-cardiac surgery. Eur Heart J. 2017 Aug 14;38(31):2409–17
  6. Smilowitz NR, Redel-Traub G, Hausvater A, Armanious A, Nicholson J, Puelacher C, et al. Myocardial Injury After Noncardiac Surgery: A Systematic Review and Meta-Analysis. Cardiol Rev. 2019 Nov;27(6):267–73
  7. Beaulieu RJ, Sutzko DC, Albright J, Jeruzal E, Osborne NH, Henke PK. Association of High Mortality With Postoperative Myocardial Infarction After Major Vascular Surgery Despite Use of Evidence-Based Therapies. JAMA Surg. 2020 Feb 1;155(2):131
  8. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth Universal Definition of Myocardial Infarction. J Am Coll Cardiol. 2018 Oct;72(18):2231–64
  9. Smilowitz NR, Shah B, Ruetzler K, Garcia S, Berger JS. Characteristics and Outcomes of Type 1 versus Type 2 Perioperative Myocardial Infarction After Noncardiac Surgery. Am J Med. 2022 Feb;135(2):202-210.e3
  10. Nepogodiev D, Martin J, Biccard B, Makupe A, Bhangu A, Nepogodiev D, et al. Global burden of postoperative death. The Lancet. 2019 Feb;393(10170):401
  11. Puelacher C, Gualandro DM, Lurati Buse G, Bolliger D, Marbot S, Kindler C, et al. Etiology of Peri-Operative Myocardial Infarction/Injury After Noncardiac Surgery and Associated Outcome. J Am Coll Cardiol. 2020 Oct;76(16):1910–2
  12. Korsgaard S, Schmidt M, Maeng M, Jakobsen L, Pedersen L, Christiansen CF, et al. Long-Term Outcomes of Perioperative Versus Nonoperative Myocardial Infarction: A Danish Population-Based Cohort Study (2000–2016). Circ Cardiovasc Qual Outcomes. 2022 Jul;15(7)
  13. Smit M, Coetzee AR, Lochner A. The Pathophysiology of Myocardial Ischemia and Perioperative Myocardial Infarction. J Cardiothorac Vasc Anesth. 2020 Sep;34(9):2501–12
  14. Puelacher C, Gualandro DM, Glarner N, Lurati Buse G, Lampart A, Bolliger D, et al. Long-term outcomes of perioperative myocardial infarction/injury after non-cardiac surgery. Eur Heart J. 2023 May 14;44(19):1690–701
  15. Korsgaard S, Schmidt M, Maeng M, Jakobsen L, Pedersen L, Christiansen CF, et al. Long-Term Outcomes of Perioperative Versus Nonoperative Myocardial Infarction: A Danish Population-Based Cohort Study (2000–2016). Circ Cardiovasc Qual Outcomes. 2022 Jul;15(7)
  16. Duceppe E, Patel A, Chan MTV, Berwanger O, Ackland G, Kavsak PA, et al. Preoperative Terminal Pro–B-Type Natriuretic Peptide and Cardiovascular Events After Noncardiac Surgery. Ann Intern Med. 2020 Jan 21;172(2):96
  17. Oh AR, Park J, Shin SJ, Choi B, Lee JH, Lee SH, et al. Prediction model for myocardial injury after non-cardiac surgery using machine learning. Sci Rep. 2023 Jan 26;13(1):1475
  18. Halvorsen S, Mehilli J, Cassese S, Hall TS, Abdelhamid M, Barbato E, et al. 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J. 2022 Oct 14;43(39):3826–924
  19. Kim M, Moon I, Bae S, Seo H, Jung IH. Prognostic value of preoperative left ventricular global longitudinal strain for predicting postoperative myocardial injury and mortality in patients undergoing major non-cardiac surgery (SOLOMON study). Int J Cardiol. 2023 May;378:151–8
  20. McKenzie NL, Ward RP, Nagele P, Rubin DS. Preoperative β-Blocker Therapy and Stroke or Major Adverse Cardiac Events in Major Abdominal Surgery: A Retrospective Cohort Study. Anesthesiology. 2023 Jan 13;138(1):42–54
  21. Turan A, Cohen B, Rivas E, Liu L, Pu X, Maheshwari K, et al. Association between postoperative haemoglobin and myocardial injury after noncardiac surgery: a retrospective cohort analysis. Br J Anaesth. 2021 Jan;126(1):94–101

Last update:

No citation recorded.

Last update: 2025-10-19 11:08:50

No citation recorded.