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

[Donald Ross]

When they have LM or TVD + poor LV....... most of my patients.
I hope, therefore, you are not trying to put me out of a job?
Don
On 02/05/2007, at 10:53 AM, prasannasimha wrote:

> Where in literature has it been shown that a patient who is stable  
> after an MI benefits from urgent in house revascularization ?
> Prasanna
>
> Donald Ross wrote:
>> 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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