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

[hgrmd at aol.com]

Don,
  I agree with you.  If Prasanna wants to send out critical LM's or LAD's hanging by a hair after an MI, that's his business.  Around here, if such patient went home without surgery and boxed, we'd definitely hear about it.
 
Hal 
 
-----Original Message-----
From: donross at bigpond.com
To: OpenHeart-L at lists.hsforum.com
Sent: Wed, 2 May 2007 4:40 AM
Subject: Re: [HSF] Too scared to touch.....


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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