[HSF] Too scared to touch.....

[Hgrmd at aol.com]

Ajit,
  I invested the time it took to read all of Prasanna's  abstracts.  I'm 
still not convinced that medical therapy with beta-blockers  is the way to go for 
nearly every case.  Again, if a stress test in an  asymptomatic patient shows 
a lot of myocardium with reversible ischemia, it  would be potentially 
foolhardy not to cath that patient.  Over the years,  we've been referred lots of 
patients with left mains or critical 3vd that were  cathed prior to an elective 
noncardiac procedure (usually carotid, ischemic leg,  or AAA).  We did the 
CABG, they eventually got the vascular procedure, and  they did fine.  I've yet to 
recall "graft closure" while the subsequent  case was done.  In light of the 
problems with DES, the cardiologists are  much more likely to use bare metal 
stents in such scenarios.  
  I do agree that beta blockade, possible Swan, and a competent  cardiac 
anesthesiologist suffice for the vast majority of cardiac patients  getting 
noncardiac surgery.  However, there are plenty of asymptomatic  cardiac time bombs 
waiting to explode for those that never cath and treat  preemptively.
Hal



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