Presentation Details
| The Balloon Before the Blade: A Case of Escalating Ischemia and Timely Intervention Aria H.Soltani, Paulina M.Mager, Heather L.Lander. University of Rochester Medical Center, Rochester, NY, USA |
Abstract
CASE PRESENTATION: A 78-year-old male with coronary artery disease, hypertension, and type 2 diabetes mellitus presented to the Center for Perioperative Medicine for evaluation prior to a scheduled coronary artery bypass graft (CABG). During his visit, he reported a week of worsening chest pain and mild chest pain in the clinic. An electrocardiogram (EKG) was performed which revealed inferolateral ST depressions. His cardiothoracic surgeon was notified, Emergency Medical Services was called, and the patient was placed on oxygen. He received nitroglycerin and was transported to Strong Memorial Hospital. He was urgently taken to the cardiac catheterization lab for possible percutaneous coronary intervention but was found to not be a candidate for PCI. Due to refractory angina and ST depressions, the patient was placed on a nitroglycerin infusion and an intra-aortic balloon pump was placed. He was transferred to the ICU and urgent CABG was performed. He was discharged on day 11.
DISCUSSION: This case underscores the critical diagnostic value of perioperative clinics, where routine preoperative assessment can unexpectedly uncover life-threatening cardiac instability. Despite presenting for an elective CABG evaluation, the patient’s report of rest angina prompted immediate in-clinic testing, triaging, and transfer to the hospital. The rapid progression from preop visit to NSTEMI recognition to mechanical support highlights how preoperative evaluation functions as a critical safety net. Early detection, decisive triage, and seamless coordination with cardiology and cardiac surgery ensures that patients avoid catastrophic outcomes and receive timely definitive treatment.
CONCLUSIONS: This case demonstrates that a comprehensive perioperative evaluation is an opportunity to not only perform optimization but also identify unstable pathology that requires immediate action.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
DISCUSSION: This case underscores the critical diagnostic value of perioperative clinics, where routine preoperative assessment can unexpectedly uncover life-threatening cardiac instability. Despite presenting for an elective CABG evaluation, the patient’s report of rest angina prompted immediate in-clinic testing, triaging, and transfer to the hospital. The rapid progression from preop visit to NSTEMI recognition to mechanical support highlights how preoperative evaluation functions as a critical safety net. Early detection, decisive triage, and seamless coordination with cardiology and cardiac surgery ensures that patients avoid catastrophic outcomes and receive timely definitive treatment.
CONCLUSIONS: This case demonstrates that a comprehensive perioperative evaluation is an opportunity to not only perform optimization but also identify unstable pathology that requires immediate action.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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