[Acute myocardial infarction as an incidental finding: reflections on the preanesthesia evaluation].
A preoperative electrocardiogram in a 16-year-old boy scheduled for surgery for a fractured radius and mandibular condyle after a motorcycle accident showed signs of myocardial ischemia as an incidental finding. Coronary arteriography revealed complete occlusion of the anterior descending artery, confirming a diagnosis of acute coronary syndrome with ST elevation, with no myocardial viability. As the patient's general condition was acceptable, to prevent severe functional sequelae, surgery was rescheduled for 17 days later. An axillary block was well tolerated at that time. While indiscriminate ordering of preoperative tests is not recommended in the literature, such testing continues to be practiced in many hospitals, possibly for reasons of organization and legal cover. In our case, the electrocardiogram made it possible to diagnose a severe lesion and adjust the anesthetic technique to suit this situation, thereby possibly preventing devastating consequences. We recommend performing an electrocardiogram on all patients with suspected blunt chest trauma, regardless of the severity of the lesions, particularly in patients scheduled for surgery.
Ruiz-Gimeno
J I
JI
Servicio de Anestesiología y Reanimación, Hospital de Rehabilitación "La Fe", Valencia. jiruizg@hotmail.com
Femenía
F
F
Ausina
A
A
Barberá
M
M
D000063:Accidents, Traffic; D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D000293:Adolescent; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003331:Coronary Vessels / Q000293:injuries*; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D004562:Electrocardiography / Q000706:statistics & numerical data; D005593:Fracture Fixation, Internal; D006335:Heart Injuries / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008335:Mandibular Condyle / Q000293:injuries; D008337:Mandibular Fractures / Q000628:therapy; D009104:Multiple Trauma; D009407:Nerve Block; D011300:Preoperative Care; D011885:Radius Fractures / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000150:complications*
D002317:Cardiovascular Agents