Author of

• 15530

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  P3.06 - Poster Session/ Screening and Early Detection (ID 220)

  • Event: WCLC 2015
  • Type: Poster
  • Track: Screening and Early Detection
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)

  • 15547

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    P3.06-017 - The Search for Cancer: Procedures in High Risk Patients: Elevated Cardiac Risk in Patients Undergoing Bronchoscopy (ID 2376)

    09:30 - 09:30  |  Author(s): D. Modi
    • Abstract

    Background:
    There has been an increased utilization of tomographic imaging to aid in the acute evaluation of patients with chest complaints and in high-risk patients to screen for lung cancer with the recently reported National Lung Screening Trial (NLST). In particular, utilization of CT-angiograms in the emergency room may, increasingly, identify patients presenting with concurrent cardiac injury and imaging abnormalities concerning for lung cancer.
    
    Methods:
    We present the case of a 75 year old male with chest pain and a non-resolving pulmonary infiltrate concerning for lung cancer. Although the chest pain was felt to be secondary to the pulmonary abnormality, evaluation by the bronchoscopy and anesthesia services revealed severe hypertension and an elevated troponin. The procedure was cancelled and cardiology was consulted with cardiac evaluation, control of blood pressure, and subsequent bronchoscopy.
    
    Results:
    Although review of the literature revealed extensive study of preoperative risk stratification for surgery there was a paucity of studies regarding the performance of bronchoscopy in the setting of hypertension and possible silent ischemia, particularly in patients with concurrent elevated troponin levels. We use this case to review the current literature and propose recommendations in the setting of cardiac ischemia with a rapid pathway for evaluation and treatment to allow needed bronchoscopic diagnostic procedures.
    
    Conclusion:
    Bronchoscopy in patients with hypertension or chest pain, particularly in the setting of elevated troponins, is poorly studied and may result in an increased risk of silent ischemia. Consideration for additional cardiac evaluation or peri-operative use of beta-blockers is warranted. Additionally, prospective studies to determine the incidence of silent ischemia in patients, such as presented, should be considered.