|An elderly man presents on day 3 post-aortic abdominal aneurysm repair. He has primary malignant hypertension, type 2 diabetes mellitus, angina, chronic kidney disease and is a smoker. He is on spironolactone and Arthrotec but not antidiabetic medications. He is complaining of shortness of breath, palpitations and chest pain.
Full blood count: polycythaemia
Urea and electrolytes: mild renal impairment
Chest X-ray: hyper-expanded lungs, ?pulmonary oedema, ?right lower lobe consolidation, raised right hemidiaphragm, enlarged heart
ECG: irregular heart rate (100-150 bpm), ST depression and inverted T waves over various, but not all, regions.
1. What is going on in this case and why?
2. What could have been done to prevent it?
3. What treatment should be given?
4. Why do myocardial infarctions etc. typically occur at day 3 post-aortic abdominal aneurysm repair?
5. What would you do about the renal impairment?
6. What could have been done differently?
7. Which drugs should he be taking?
8. What renal protection can be employed at the time of the operation?
9. When would be the best time for this patient to receive haemofiltration?