Monday, September 12, 2011

You're in Court... I

This week's cases are about pre-operative evaluations gone wrong.

A 70 year old gentleman presents to the pre-operative clinic because he is scheduled for a repair of a 6cm abdominal aortic aneurysm. His other medical problems include HTN, DM, COPD, arthritis, GERD, and obesity. He is an active smoker, though trying to cut down. His medications include losartan, metformin, tiotropium, albuterol, fluticasone, omeprazole, ibuprofen, and aspirin. Due to his arthritis and COPD, his exercise tolerance is one flight of stairs slowly. However, when he climbs a flight of stairs, he gets mild substernal chest pain which stops when he rests. It has been going on for several months but has not changed in character, severity, or frequency. EKG is NSR with LVH. Troponin is negative. Because of his reactive airway disease, adenosine stress test is contraindicated. You order a dobutamine stress test prior to his vascular surgery and refer him to cardiology.

Challenge: You're in court...Why?

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1 comment:

Craig Chen said...

You’re in Court... I

Dobutamine stress test is contraindicated in a patient with a AAA as there is concern for rupturing the aneurysm due to the increased heart rate and blood pressure during the test.

Source: UpToDate.