Chest pain and shortness of breath are frequently encountered medical problems in the postoperative period. The time at which they appear after surgery is important in determining their cause. This chapter reviews the possible causes for these presenting symptoms.

Myocardial infarction

Chest pain in the postoperative period is always worrisome because of the possibility of myocardial infarction (MI). This concern is well founded. Mortality rates are 30% to 50% for a first postoperative MI and even higher for subsequent MIs in the perioperative period. Although no data are available concerning specific treatment in this situation, standard therapy for MI is likely to be helpful.

The incidence of postoperative MI approaches zero in patients who have no history of, or possess risk factors for, ischemic heart disease compared to 6% in those with a history of ischemic heart disease. The incidence of postoperative MI has been reported to peak between 3 and 5 days after surgical procedures. More recently, this at risk period has been found to occur as early as 24 to 48 hours after surgery.

Two groups of patients appear to be at greatest risk for postoperative MIs and probably sustain the largest number of postoperative MIs as well: those with clinically diagnosed coronary artery disease and those with significant peripheral vascular disease. Diagnosing postoperative MI can be difficult. Incisional pain, gastrointestinal or respiratory complications, and sedative and pain medications may obscure symptoms.