Key result
A 79-year-old male developed a clinically silent myocardial infarction with new Q waves and apical thrombus following endovascular surgery, despite a negative preoperative stress echocardiogram.
Case Report (n=1)
This case highlights that clinically silent myocardial infarctions can occur and be detected postoperatively despite a recent negative preoperative cardiovascular risk evaluation.
Silent perioperative MI can occur despite negative stress echocardiography; leaves open the value of routine preoperative testing in vascular surgery.
In this case, a 79-year-old male presented with new anteroseptal Q waves and T-wave inversions across the precordial leads following an otherwise uneventful endovascular repair of his thoracoabdominal aortic aneurysm. The patient had no history of cardiac disease and had undergone a dobutamine stress echocardiogram within the preceding 6 months that showed no evidence of inducible ischemia. Nevertheless, routine postoperative electrocardiogram (EKG) revealed new Q waves and T-wave inversions and transthoracic echocardiogram that demonstrated akinesis of the left ventricle (LV) apex with chronic-appearing apical thrombus. We will further discuss preoperative evaluation of cardiovascular risk along with postoperative interpretation of EKG abnormalities.
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Delaney et al. (2019) conducted a case report in Clinically silent myocardial infarction (n=1). Endovascular repair of thoracoabdominal aortic aneurysm was evaluated on Clinically silent myocardial infarction (new Q waves, T-wave inversions, LV apex akinesis with apical thrombus). A 79-year-old male developed a clinically silent myocardial infarction with new Q waves and apical thrombus following endovascular surgery, despite a negative preoperative stress echocardiogram.
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