Title : Evidence of Multiple Vessel Disease on Coronary Angiography: A Case of Preoperative Cardiac Evaluation
Abstract:
Triple vessel coronary artery disease is a life-threatening cardiovascular condition. Patients who are asymptomatic yet have a high pretest probability should undergo an appropriate diagnostic test before the occurrence of an adverse event. Case presentation: A 68-year-old male with a past medical history significant for hypertension, hyperlipidemia, type 2 diabetes mellitus, prostate cancer, and strong family history of sudden cardiac death, presented to the outpatient clinic for a preoperative cardiac evaluation. He was scheduled for prostatectomy surgery in the same month. He had no cardiorespiratory complaints. Physical exam, vitals, and labs were within normal limits. His metabolic equivalents (METs) score was 8 points, and the revised cardiac risk index (RCRI) score was class 1 risk. The electrocardiogram showed normal sinus rhythm, with no acute changes. He underwent an exercise stress test in view of strong pretest probability. He was found to have significant ST depression in multiple leads, both during the activity and recovery phases. The cardiac troponins were ordered, which were normal. Results: Due to concerning abnormalities on the exercise stress test and strong risk factors, he underwent cardiac catheterization. The cardiac catheterization showed multivessel coronary occlusive disease. Decision making: The critical findings of the coronary angiogram were explained to the patient. The prostatectomy surgery was withheld. He underwent coronary artery bypass graft in view of multivessel occlusive disease and known history of diabetes. Conclusion: The diagnosis of coronary artery disease should be based on both pretest probability and the sensitivity of each diagnostic test. Cardiac catheterization is highly sensitive in detecting the anatomical location and severity of stenosis in the coronary arteries. Abnormalities noted on a particular test should always be followed by a further evaluation to prevent near misses or adverse events.
What will audience learn from your presentation?
• Asymptomatic patients can have critical underlying coronary artery diseases. • Pretest probability plays a crucial role in deciding appropriate diagnostic tests.
• Understand the sensitivity and specificity of each diagnostic test, such as electrocardiogram, exercise stress test, myocardial perfusion can and coronary angiogram.
• Abnormal results of one diagnostic test should be followed by further evaluation. • Importance of coronary angiography in detecting anatomical location and degree of stenosis.
• Extent and location of stenosis aids in further deciding between percutaneous coronary intervention and coronary artery bypass graft.
