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Old 10-19-2011
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Default Cardiology

A 72-year-old man is found to have an asymptomatic 7-cm abdominal aortic aneurysm. Surgical repair has been recommended. In the ensuing evaluation, it is determined that he suffers from severe progressive angina. He has not had a recent myocardial infarction and he is not currently in heart failure. Which of the following is the most prudent course of action?
A. Evaluate him for coronary revascularization before aneurysmal repair
B. Leave him alone and not plan to do anything for his asymptomatic aneurysm
C. Operate his aneurysm under cardiopulmonary bypass
D. Treat him with diuretics and beta-blockers before surgery
E. Wait at least 6 months before doing the surgery
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Old 10-19-2011
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A. Evaluate him for coronary revascularization before aneurysmal repair????
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Old 10-20-2011
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A..evaluate him for coronary revascularisation
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D. Treat him with diuretics and beta-blockers before surgery
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Old 10-20-2011
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A cath and then elective repair! goldmann risk with severe CAD should be evaluated with cath first.
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Old 10-20-2011
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The correct answer is A. The risk for operating on him now is that of a perioperative coronary event. The risk can be minimized if coronary revascularization precedes aneurysmal repair. There is no guarantee that he will be a suitable candidate for the coronary revascularization, but he should be evaluated.

Leaving alone a 7-cm aneurysm (choice B) ignores the high risk for rupture that accompanies an aneurysm of that size. Should that happen, emergency surgery in the face of the uncorrected coronary disease would be fatal.

Working on the abdominal aorta does not require cardiopulmonary bypass (choice C), and doing it would not modify his coronary risk.

If he were in failure, medical management to get him out of failure would be in order (choice D). That is not his current problem.

Waiting 6 months (choice E) is the standard answer when a recent transmural infarction has occurred.
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The above post was thanked by:
pass7 (10-20-2011), samstar (12-08-2011), sonu.agarwall (10-20-2011)



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