PATIENT: 45-year-old man
CHIEF COMPLAINT: This patient presented with marked exertional angina. The angina had first appeared approximately 3 years earlier and had become progressively more frequent and severe. A number of medications had been tried; however, the patient continued to have exertional angina.
MEDICAL HISTORY: With the exception of angina, the patient had been free of other physical illnesses. As a youngster, the patient had undergone tonsillectomy with adenoidectomy as well as left inguinal herniorrhaphy. No bleeding was associated with either surgical procedure.
FAMILY HISTORY: There was a history of diabetes mellitus on the maternal side of the family. On the paternal side, there was a history of coronary artery disease. A number of male relatives had died at young ages of myocardial infarction.
DRUG HISTORY: The patient had been taking nitroglycerin since the onset of the angina. In addition, he had taken propranolol (beta-adrenergic blocking agent). More recently, the calcium antagonist nifedipine had been added to his regimen. As noted above, none of these medications had been effective in controlling the clinical symptoms.
PHYSICAL EXAMINATION: Unremarkable
HOSPITAL COURSE: After admission, the patient underwent coronary arteriography. Significant narrowing of the left anterior descending coronary artery was noted, with greater than 80% of the lumen being occluded. There was also significant narrowing of the circumflex branch of the left coronary artery. It was thought that the patient would benefit from a bypass procedure. Before the operation was done, a panel of coagulation screening tests was performed.
|
|
Patient |
Normal |
|
|
|
|
|
Prothrombin
time |
12
seconds |
8-11.5
seconds |
|
aPTT |
35
seconds |
24-37.5
seconds |
|
Platelet
count |
310,000/μl |
150,000-350,00/μl |
A two-vessel coronary artery bypass procedure was performed with saphenous vein grafts. After the operation, there was oozing from the surgical site. Consequently, coagulation laboratory was consulted.