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

Donald Ross donross at bigpond.com
Thu May 3 10:09:37 EDT 2007 

Ani, one good anecdote deserves another.
I once sent a young man with stable LM home ( completely asymptomatic  
and found on speculative stress test)  because we had a hospital full  
of  elderly unstable patients who seemed to deserve more urgent  
attention.
The man died in front of his young children a week later!
Don
On 03/05/2007, at 2:18 AM, Ani Anyanwu wrote:

> What is the evidence base for emergent revasularization of Left  
> Main? When I worked in England few years back we had patients with  
> Left Main on the waiting list for surgery for as long as a year.
>
> ANi
>   ----- Original Message -----
>   From: prasannasimha<mailto:prasannasimha at gmail.com>
>   To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart- 
> L at lists.hsforum.com>
>   Sent: Wednesday, May 02, 2007 6:43 AM
>   Subject: Re: [HSF] Too scared to touch.....
>
>
>   Even TVD doesn't have evidence base for emergent inhouse
>   revascularization. Only Left main.
>   Prasanna
>   Donald Ross wrote:
>> 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<mailto: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
>>>>>
>>>>>
>>>>>
>>>>> ************************************** See what's free at
>>>>> http://www.aol.com<http://www.aol.com/>.
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