A 58 year-old man has been in progressive coronary insufficiency for at least five years, with angina of effort and recent early signs of left ventricular failure.

Cardiac catherization revealed atherosclerotic obstruction of both the left anterior descending and circumflex arteries. Coronary artery bypass graft (CABG) operation schedule, since cardiac failure appeared imminent.

The patient was on a daily regimen of nicardipine at the time of surgery.

case author: Hugh S. Mathewson,
M.D., Professor Emeritus, School of Allied
Health, Department of Nurse Anesthesia,
University of Kansas Medical Center

case editor: Michael Gordon, Ph.D. Associate
Professor of Pharmacology and Surgery, School of
Medicine, Department of Pharmacology, University
of Kansas Medical Center