In January 1998, at Medicine Grand Rounds,
Lee Goldman, MD, discussed Mrs H, a 75-year-old woman weighing the
risks and benefits of proceeding with an elective repair of an
abdominal aortic aneurysm.1 She had survived an emergency
repair of a thoracic aneurysm and was troubled mostly by chronic
dyspnea secondary to her severe chronic obstructive pulmonary
disease.
Cardiac evaluation prior to her aneurysm resection showed no evidence
of ischemic heart disease. However, in the past several months, she
developed chest pain and was admitted to the hospital. Although cardiac
enzyme levels were normal, her electrocardiogram and echocardiogram
results reflected anterior myocardial infarction. Given her age and
comorbidities, Dr Goldman had suggested a watchful waiting strategy,
including serial measurement of the aneurysm size.