Cardiac vulnerability under anesthesia; an epidemiologic review of the cardiology-anesthesiology interface

Abstract

Perioperative cardiac complications remain a major source of morbidity and mortality in surgical patients, particularly in the context of an aging global population and rising cardiovascular disease prevalence. This narrative review synthesizes epidemiologic evidence, risk factors, underlying pathophysiological mechanisms, anesthetic considerations, and interdisciplinary management strategies at the cardiology–anesthesiology interface to inform perioperative care and improve outcomes. Current evidence shows that perioperative cardiac complications, including myocardial injury after non-cardiac surgery, perioperative myocardial infarction (PMI), heart failure, arrhythmias, and cardiac arrest, occur in approximately 3–8% of major non-cardiac surgeries and are associated with substantial short‑ and long‑term mortality. Risk is highest among elderly individuals, patients with established cardiovascular disease, and those undergoing high‑risk or urgent procedures. Mechanisms of vulnerability include myocardial oxygen supply–demand imbalance, plaque rupture, systemic inflammation, and anesthesia‑ or surgery‑induced hemodynamic instability. Anesthetic agents exert variable effects on cardiac function, underscoring the importance of vigilant intraoperative monitoring and hemodynamic optimization. Evidence supports routine risk stratification using validated tools, perioperative troponin surveillance in high‑risk patients, individualized anesthetic and hemodynamic strategies, and multidisciplinary collaboration.

Keywords: Perioperative cardiac Complications, Myocardial injury after noncardiac surgery, Anesthesia, Hemodynamic monitoring, Interdisciplinary management, Cardiac anesthesia