Preoperative cardiac risk assessment and management of elderly men with an abdominal aortic aneurysm
A 72-year-old male presented with an abdominal aortic aneurysm. He had a history of chest pain complaints and underwent percutaneous transluminal coronary angioplasty (PTCA) 6 years ago. After the PTCA procedure he had no chest pain symptoms until 2 years ago. The chest pain complaints are stable and he was able to perform moderate exercise, such as a round of golf, in 4.5 h. Physical examination showed a friendly man, with blood pressure 160/70 mmHg and pulse 92 bpm. Examination of the chest revealed no abnormalities of the heart. Palpation of the abdomen showed an aortic aneurysm with an estimated diameter of 7 cm. The patient was referred to the vascular surgeon. Blood test showed an elevated fasting glucose of 10.0 mmol/l and low-density lipoprotein (LDL) cholesterol of 4.1 mmol/l. Electrocardiography showed a sinus rhythm and pathological Q-waves in leads V1-V3, suggestive of an old anterior infarction.