Case 1—Cardiology consult before noncardiac surgery for brain tumor

History

A 72-year-old Caucasian woman presented with a recent onset of headaches and visual changes and was found to have two cerebral tumors with surrounding edema in the right parietal and occipital lobes on brain MRI.

There was a history of colon adenocarcinoma surgery 4 years ago.

Cardiology was consulted by neurosurgery for cardiac clearance for brain surgery due to two consecutive troponin levels of 37 and 47 over a 24-hour period (n ≤ 10 ng/L) and a cardiac murmur. There was no prior cardiac history and no history of chest pain during current admission.

Physical examination

Patient’s functional capacity was >4 metabolic equivalents (METS). There was a 2/6 ejection systolic murmur over the right second intercostal space.

Laboratory values

Serum creatinine was 1.9 mg/dL (normal <1.04) and had been increasing over the last 2 days.