title: Massive postoperative rhabdomyolysis following combined CABG/abdominal aortic replacement: a possible association with HMG-CoA reductase inhibitors.
abstract: OBJECTIVE
  The beneficial effects of the treatment of hyperlipidemia in the secondary prevention of ischemic heart disease are well established. Pravastatin is a 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitor often prescribed for the treatment of hypercholesterolemia. Occasional side effects include increased creatine kinase levels and myalgias worsened by exertion, rarely presenting with severe myopathy and rhabdomyolysis resulting in myoglobinuria and renal failure.
  
  
  METHODS
  We report on a case of a 68-year-old male patient who developed rhabdomyolysis, severe myoglobinuria, and acute renal failure following uneventful coronary bypass grafting surgery (CABG) combined with infrarenal replacement of the abdominal aorta. The patient presented with numerous risk factors for development of rhabdomyolysis following surgical intervention. We underscore important contributory factors and discuss differential diagnostic considerations e.g., malignant hyperthermia and neuroleptic malignant syndrome in such patients.
  
  
  CONCLUSIONS
  Considering the high risk of perioperative mortality in patients that routinely take fat lowering substances, we suggest to discontinue the intake prior to surgical interventions.
authors.affiliation: Division of Thoracic-, and Cardiovascular Surgery, Medical School Hanover, Hanover, Germany. Wilhelmi@thg.mh-hannover.de
authors.forename: Mathias
authors.initials: M
authors.lastname: Wilhelmi
authors.forename: Michael
authors.initials: M
authors.lastname: Winterhalter
authors.forename: Stefan
authors.initials: S
authors.lastname: Fischer
authors.forename: Thorsten
authors.initials: T
authors.lastname: Walles
authors.forename: Janusz
authors.initials: J
authors.lastname: Zuk
authors.forename: Martin
authors.initials: M
authors.lastname: Strüber
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology; D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000188:drug therapy; D008297:Male; D009212:Myoglobinuria / Q000175:diagnosis / Q000209:etiology; D011183:Postoperative Complications; D017035:Pravastatin / Q000009:adverse effects / Q000627:therapeutic use; D012206:Rhabdomyolysis / Q000175:diagnosis / Q000209:etiology*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017035:Pravastatin