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

Thu May 3 10:12:30 EDT 2007

Dear Donald,
Yes agee, one anecdote deserves another. Also in England, 15 years ago, I
was taught that revascularization is either for symptomatic or prophylactic
indications. the Only PROPHYLACTIC indication was in critical LM stenosis
... !! .... simply meaning not to be left till patient is symptomatic .....
that would be first and last symptom !!!

NFA

On 5/2/07, Donald Ross <donross at bigpond.com> 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/>.
> >>>>> _______________________________________________
> >>>>> OpenHeart-L mailing list
> >>>>>
> >>>>> Send postings to:
> >>>>>  OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-
> >>>>> L at lists.hsforum.com>
> >>>>>
> >>>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> >>>>> http://mmp.cjp.com/mailman/listinfo/openheart-l<http://
> >>>>> mmp.cjp.com/mailman/listinfo/openheart-l>
> >>>>>
> >>>>> All messages transmitted by the OpenHeart-L are subject to the
> >>>>> policies and
> >>>>> disclaimers posted at:
> >>>>> http://www.hsforum.com/listdisclaim<http://www.hsforum.com/
> >>>>> listdisclaim>
> >>>>> -----------------------------------------
> >>>> _______________________________________________
> >>>> OpenHeart-L mailing list
> >>>>
> >>>> Send postings to:
> >>>> OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> >>>>
> >>>> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> >>>> http://mmp.cjp.com/mailman/listinfo/openheart-l<http://
> >>>> mmp.cjp.com/mailman/listinfo/openheart-l>
> >>>>
> >>>> All messages transmitted by the OpenHeart-L are subject to the
> >>>> policies anddisclaimers posted at:
> >>>> http://www.hsforum.com/listdisclaim<http://www.hsforum.com/
> >>>> listdisclaim>
> >>>> -----------------------------------------
> >>>>
> >>> _______________________________________________
> >>> OpenHeart-L mailing list
> >>>
> >>> Send postings to:
> >>> OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> >>>
> >>> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> >>> http://mmp.cjp.com/mailman/listinfo/openheart-l<http://
> >>> mmp.cjp.com/mailman/listinfo/openheart-l>
> >>>
> >>> All messages transmitted by the OpenHeart-L are subject to the
> >>> policies and disclaimers posted at:
> >>> http://www.hsforum.com/listdisclaim<http://www.hsforum.com/
> >>> listdisclaim>
> >>> -----------------------------------------
> >> _______________________________________________
> >> OpenHeart-L mailing list
> >>
> >> Send postings to:
> >> OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> >>
> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> >> http://mmp.cjp.com/mailman/listinfo/openheart-l<http://mmp.cjp.com/
> >> mailman/listinfo/openheart-l>
> >>
> >> All messages transmitted by the OpenHeart-L are subject to the
> >> policies anddisclaimers posted at:
> >> http://www.hsforum.com/listdisclaim<http://www.hsforum.com/
> >> listdisclaim>
> >> -----------------------------------------
> >>
> >>
> >
> >   _______________________________________________
> >   OpenHeart-L mailing list
> >
> >   Send postings to:
> >    OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>
> >
> >   To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> >   http://mmp.cjp.com/mailman/listinfo/openheart-l<http://
> > mmp.cjp.com/mailman/listinfo/openheart-l>
> >
> >   All messages transmitted by the OpenHeart-L are subject to the
> > policies and
> >   disclaimers posted at:
> >   http://www.hsforum.com/listdisclaim<http://www.hsforum.com/
> > listdisclaim>
> >   -----------------------------------------
> > _______________________________________________
> > OpenHeart-L mailing list
> >
> > Send postings to:
> >  OpenHeart-L at lists.hsforum.com
> >
> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> > http://mmp.cjp.com/mailman/listinfo/openheart-l
> >
> > All messages transmitted by the OpenHeart-L are subject to the
> > policies and
> > disclaimers posted at:
> > http://www.hsforum.com/listdisclaim
> > -----------------------------------------
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
> OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the policies
> and
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
>

-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC