ArticleCureus2026
Silent Intraoperative Right Coronary Artery Occlusion at a Prior Stent Site Progressing to Ventricular Fibrillation During Hip Hemiarthroplasty: A Case Report.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
Perioperative myocardial infarction may occur without typical ischemic symptoms in elderly patients undergoing hip fracture repair. We describe the case of an 86-year-old woman with hypertension, coronary artery disease, and prior right coronary artery stenting who underwent right hip hemiarthroplasty under spinal anesthesia after clopidogrel had been withheld for one week. Continuous electrocardiographic monitoring showed progressive ST-segment elevation first recognized by the anesthesia nurse, who verified the finding and immediately informed the anesthesiology team. ST-segment elevation preceded a decline in heart rate and blood pressure and was followed by ventricular fibrillation during emergency transfer for coronary angiography. Repeated cardiopulmonary resuscitation and 200-J defibrillation produced transient rhythm recovery, with recurrent ventricular fibrillation until coronary reperfusion. Angiography showed acute right coronary artery occlusion at the previous stent site with thrombus; balloon angioplasty, intracoronary tirofiban, and implantation of a 2.75 × 29 mm drug-eluting stent restored TIMI grade 3 flow, with approximately 30% residual stenosis. Troponin T was >50 ng/mL on postoperative day 1, 4056 ng/mL on day 5, and 900 ng/mL on day 9; no major bleeding, transfusion, or neurological complications were documented. The patient ambulated before discharge on postoperative day 15. This case illustrates a descriptive temporal sequence in which progressive monitor-detected ST-segment changes preceded hemodynamic deterioration and subsequent ventricular fibrillation, followed by nursing verification, escalation, and multidisciplinary rescue; it does not establish that any specific monitoring or escalation strategy altered the outcome. Because this is a single case, the chronology described is observational and does not permit causal inference regarding the outcome.
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