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71-Year-Old Man Presenting With Postoperative Chest Tightness
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71-Year-Old Man Presenting With Postoperative Chest Tightness
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71-Year-Old Man Presenting With Postoperative Chest Tightness
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Journal Article
71-Year-Old Man Presenting With Postoperative Chest Tightness
2019
Overview
2.Which one of this patient's risk factors would most strongly increase his risk of a perioperative cardiovascular event? a. Previous malignancy b. First-degree AV block c. Creatinine level of 1.2 mg/dL d. Diabetes mellitus treated with insulin e. Hemoglobin level of 10.3 g/dL A commonly used and well-validated perioperative cardiac risk model is the Revised Cardiac Risk Index outlined by Lee et al.2 In an analysis of 2893 consecutive patients undergoing noncardiac surgery, 6 independent risk factors were identified. The patient continued to deny any chest pain, palpitations, shortness of breath, orthopnea or other signs of ischemic cardiac disease or congestive heart failure. 3.Given the previously noted findings, which one of the following would you use to treat the newly found left apical thrombus? a. No acute treatment, follow up in 3 months b. Surgical thrombectomy c. Intravenous heparin bridging to warfarin d. Intravenous thrombolysis e. Low-dose aspirin and clopidogrel The main risk associated with an intracardiac thrombus is a cardioembolic event, primarily stroke. [...]the incidence of left ventricular thrombus has been reported to be as high as 1.3% of patients with stress-induced cardiomyopathy.12 The primary goal of treatment is prevention of cardioembolic phenomena, in particular, stroke. There are currently limited data regarding using direct oral anticoagulants in this scenario, and this may be a future area of research. [...]apical ballooning syndrome should be high on one's differential diagnosis, especially in the setting of an acute stressor.
