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

Thu May 3 00:34:22 EDT 2007

In countries like Australia where the public system creates waiting 
lists, many patients with what is usually referred to as critical LM 
or 3VD get sent home and wait. If they have no symptoms, they may not 
get done for months. Do they die, rarely. The studies have been done 
and do not show an inordinate mortality. Now, of course medical 
therapy is better than it used to be and they are treated well. Quite 
a few bounce back and it it those who get done.
I am not saying it is right, but it is another piece of evidence we 
must consider. The Canadians have also a lot of data on this. Tuman 
comes to mind.

>Hal,
>Please read carefully, In never said anything about critical left mains.
>Also if you carefully see what I said I said where is the evidence . 
>Some things that we practice need not necessarily be right.
>
>Prasanna
>hgrmd at aol.com wrote:
>>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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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon