Very Radical Prostatectomy

Report:

Sinus tachycardia 134/min

ST/T changes c/w infarction/ischæmia

Comment:

Urology disasters were commonplace when I was young. With better perioperative care and more assertive anæsthetic departments they are no longer a regular feature of hospital life. Some patients, like this one, still slip through the system.

There is no way of telling whether diffuse marked ST depression seen here is ischæmic or infarctional. The answer came with troponin rise to 24.2 and CPK to 1649 IU. The patient improved steadily on non-invasive (BiPAP) ventilation and the ECG taken in the first hour showed lessening of ST depression and slowing of the sinus rate (Fig 22a). The changes resolved almost completely (Fig 22b) prior to transfer to CCU.

The last ECG (Fig 22c) is his preoperative trace from the Pre-admission Clinic. It has the T3 > T1 and TV1 > TV6 features consistent with the patient’s history of angina pectoris. The latter was never investigated except by this ECG which was never contemplated or understood.

22a. A stress test would stop at this stage: it should never reach the ST segment depression seen in Fig 22 above. 22b. 22c. This preoperative ECG would have been a dangerous document in Coroner’s Court had the patient died from his infarction. 24. 38 year old man with chest pain. Right-sided chest leads are used for this recording. Why?