[HSF] Too scared to touch.....
Prasanna Simha M
prasannasimha at gmail.com
Thu May 3 16:06:47 EDT 2007
Now Don and Hal will be after you too.
Prasanna
On 5/3/07, Ani Anyanwu <anianyanwu at hotmail.com> wrote:
>
> This is not necessarily the case that patients will be alive if they had
> been kept in hospital though.
>
> 1) Patients also die as inpatients while awaiting surgical referral,
> consultation or operation. Being in hospital does not save you from sudden
> death unless you are at right place at right time (e.g. empty operating
> room available in daytime). Sudden cardiac death remains a major cause of
> mortality in CCU and cardiology wards, and when it happens is often
> irretrievable despite being in hospital.
>
> 2) Patients die during and after surgery. How do we know that patients who
> are at risk of sudden death are not also at risk of peri-operative death, or
> early or medium term death? I am sure most would have seen a few over the
> year die on induction of anesthesia, albeit a rare occurrence these days I
> agree.
>
> Cardiovascular disease remains, and will remain for a while, the leading
> cause of death in Western Adults - I think it is simplistic to believe that
> any tertiary intervention, that does not include prevention or *cure* of
> disease (including if we are all hospitalized) will change that.
>
> Ani
> ----- Original Message -----
> From: Donald Ross<mailto:donross at bigpond.com>
> To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> Sent: Thursday, May 03, 2007 12:22 AM
> Subject: Re: [HSF] Too scared to touch.....
>
>
> My point had nothing to do with resources.
> It just illustrates that severe coronary disease kills at any time.
> When we had waiting lists we kept a record on cardiac deaths and they
> did occur and most were not LMD.
> MY POINT IS: that all these patients would be alive if they had had
> in house surgery despite what some Canadian study purports to say.
> Incidentally, I bet the Canadian study was funded by the mean
> government which doesn't want to fund it's heath care appropriately.
> Don.
> > Don - so the spa hospital has 60 % left main and emergent TVD"s -
> > you missed the point !!!
> > Yes - you yourself are making a point with the statement
> > "Do you really believe all Bojan's waiting list deaths had critical
> > LM disease?"
> > So - Do you think all waiting list deaths are left main disease -
> > slightly rephrased and now does it appear the same ? Then that
> > argument for left main itself becomes more tenuous !!
> > I am not saying that left mains should all be operated when
> > armegaddon comes but the reflex "in house" rush for surgery is more
> > of a creation than a real necessity He can be operated at an early
> > elective slot and doesn't really have to be rushed from the cath
> > lab to the OR.
> > Prasanna
> >
> > Donald Ross wrote:
> >> Prasanna,
> >> Indeed, a lot of what we practice will be found to be imperfect ,
> >> but a lot of the so called evidence based practice is also bullshit.
> >> Do you really believe all Bojan's waiting list deaths had critical
> >> LM disease?
> >> Remember the bikini and statistics?
> >> Don
> >>
> >> PS It is great to have Hal onside for a change!
> >>
> >> On 02/05/2007, at 9:20 PM, psimha wrote:
> >>
> >>> 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<mailto: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<mailto:donross at bigpond.com>
> >>>> To: OpenHeart-L at lists.hsforum.com<mailto:
> 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<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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--
Prasanna Simha M
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