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

Thu May 3 15:16:46 EDT 2007

So s..t happens. We only have finite resources and have to juggle 
them. I have seen the same happen in older patients. But I have also 
had a few go home and die postop or what about the ones that present 
with  sudden death etc etc.

>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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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon