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June 6, 1977

Myocardial Ischemia Associated With Transtracheal Aspiration

JAMA. 1977;237(23):2527-2528. doi:10.1001/jama.1977.03270500079036

ACCURATE interpretation of cultures of expectorated secretions is frequently impossible because such material contains microorganisms from the mouth and not present in the lower respiratory tract. Numerous studies have documented the value of transtracheal aspiration in identifying pathogens from the lower respiratory tract, and although all have stressed its safety,1 occasional serious morbidity or even mortality has been noted.2 We describe a patient in whom myocardial ischemia occurred during transtracheal aspiration and call attention to the importance of adequate oxygenation for patients having this procedure.

Report of a Case  A 52-year-old hypertensive man was readmitted to the hospital 20 days after right pneumonectomy for squamous cell carcinoma because of progressive shortness of breath, five-pillow orthopnea, and paroxysmal nocturnal dyspnea. Rales were present over the left lung base; an S3 gallop was heard, but otherwise there were no signs of heart failure. His electrolyte and BUN levels were within