Prof Montage is a cardiologist who runs a website discussing cardiology cases. The document describes the medical history of an 84-year-old female patient who suffered multiple complications following surgery to repair a hip fracture. Over several weeks, she developed issues including heart failure, sepsis, blood clots, and adrenal insufficiency. The long case highlights how her condition deteriorated as she received treatment from various specialists.

1. Introducing...
Prof Montage
Cardiology Rounds
www.profmontage.com.au
www.cardiologyrounds.com.au

2. DISCLOSURE
Over the years Prof Montage has
taken lot$ of money from
pharmaceutical companies.
He would prefer this was not widely
publicised.

6. meet the characters

7. troponins

8. Case history
84yo female, 45 kg
Past history:
hypertension
Renal artery stenosis Cr 115
Polymyalgia on steroids
Macular degeneration

9. March 2014
Peri-trochanteric #NOF
‘just twisted’ while bending
Medical review
I-V hydrocortisone
Theatre: gamma nail

14. 12 hrs postop
Rapid response, low BP
Acute AF, preexisting LBBB
d/w Cardiology ‘could be
nonSTEMI’
Transfuse 1 unit

15. 6 hours later
1300ml I-V so far
Fast AF, give Mg infusion
80 ml/hour
Now sats <90%
JMO: ‘not fluid overloaded’

17. Coronary perfusion pressure

18. 3 days later
Cardiology review re: raised
troponin
Raised venous pressure
d/w Cardiologist: give aspirin &
clopidogrel

19. Supply / demand

20. 4th post-op day
Sudden abdo pain
Laparotomy: perforated gall
bladder, biliary peritonitis
Postop: low BP, fluid bolus…etc

21. Days 7-11 post-admission
Rapid AF; i-v amiodarone
Fever ?sepsis
low BP, desaturation ?PE
Echo dilated hypocontractile LV

22. ‘consolidation’

23. Pleural tap

24. 15-18 days post admission
Transudate
‘CCF’ :Diuretics and digoxin
Fast AF: amiodarone, K, Mg
Waiting for rehab
Home day 22

25. Late July 2014
Still on bisoprolol / amiodarone
Bradycardia 35/min
Isoprenaline 4 days
Chest pain, troponin rise
Queue for pacemaker and cath

26. Day 5
Angio 2 vessel disease, no
ventriculogram
Permanent pacemaker
Postop hypertension & bleeding
Transfused, stopped clopidogrel

27. Day 6
Sudden visual loss
Retinal artery occlusion
Aspirin. “Consider warfarin”
Discharged for GP care

28. 8 days later
Chest pain, ambulance
Raised troponin
Diagnosis ‘nonSTEMI’
….and so on

29. End August 2014
Heart failure treated
Near-blindness
Adrenal insufficiency
Heading home…..

32. Right ventricle

33. 3 minute Cardiology
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