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

[Donald Ross]

Also, one wonders about the not infrequent peri-op AMIs during non- 
cardiac surgery that come our way for revascularisation prior to  
discharge.
Is this unnecessary surgery as well, given it carries the same  
indications as regular coronary surgery?
Don
On 01/05/2007, at 10:04 PM, Hgrmd at aol.com wrote:

> 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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