56-year-old man for a Radical prostatectomy for prostate cancer
- Asthma – well-controlled
- Lifelong smoker – 30 pack years
- Active, goes to the gym daily >4METS
- Inferior TWI noted on perioperative ECG
- No history of symptoms
- Echocardiogram showed ‘moderately hypertrophic LV with marginally reduced systolic function, Grade 1 diastolic dysfunction, infiltrative process cannot be excluded, and ASD with small left>right shunt.’
- Discussed at cardiology meeting regarding need for further investigations preoperatively. Cardiologist recommended that surgery proceeds, cancer surgery.
- Differential diagnosis:
- Ischaemic Heart disease – relatively normal LV systolic function is reassuring.
- Infiltrative process – E.G. Amyloidosis, unlikely but at present it is not significant. Not obvious on echo and voltages preserved on ECG. Recommends post-op outpatient cardiology review and cardiac MRI
- AHA guidelines would support proceeding without further cardiac investigations
- Normal sestamibi would be reassuring but abnormal result would likely cause delay and not change intraoperative management
- Proceed with planned procedure
- Refer to GP for postoperative cardiology referral and consideration of cardiac MRI and stress test.