[HSF] Too scared to touch.....
Tea Acuff
tacuff at swbell.net
Wed May 2 19:43:29 EDT 2007
I think that many of us have argued against this normalization of hysteria over and over based on long term personal observation.
tea
----- Original Message ----
From: prasannasimha <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Wednesday, May 2, 2007 7:35:59 PM
Subject: Re: [HSF] Too scared to touch.....
Don, this is how statistics get beat and how anecdotal experience
becomes the "norm". Incidentally an anecdote is not a virtual national
practice habit that is being referred to versus a case report.
The justification is made as if he developed that left main stenosis in
the zillionth of a second before his angio was done. He has CAD and he
is at high risk for cardiac death. Why did the "young" man get CAD ?
obviously because of risk factors. Is he at high risk for sudden death -
Yes. Is his risk higher than the average population of coronary artery
disease - that is the question to be asked and there is no literature to
support that versus those with unstable symptoms.
Arguing that the young man needed earlier surgery that the older person
is a different issue of allocation of resources etc.
Prasanna
Donald Ross wrote:
> 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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