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

[erdinç naseri]

Mark,
It is our practice to angio( coronary) any patient undergoing vascular surgery for atherosclerotic pathology in the following conditions:1.Male nondiabetic >40y/o
2.Male diabetic >35y/o
3.Postmenopausal  non diabetic female of any age.
4.Premenopausal diabetic  female>40 y/o
erdinc  > From: mmlevinson at hsforum.com> Subject: Re: [HSF] Too scared to touch.....> Date: Wed, 16 May 2007 20:53:31 -0500> To: OpenHeart-L at lists.hsforum.com> CC: > > > On May 1, 2007, at 7:04 AM, 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> >> >> > Hal:> > I agree with you. This past week, I did a CABG on a patient that > another surgeon did> a fem-tib bypass for limb salvage. Prior to her vascular surgery, > she had> an adenosine thallium, which was normal. She had no prior cardiac > symptoms> and a normal EKG. Two days after her fem-tib, she developed CHF > and this> prompted cath. A 95% left main and 70% right main was found.> > The anesthesia provider who did her fem-tib was visibly upset when he > found> out that he had done the original case on a patient with an > undiagnosed LM.> The anesthesia societies are training their members to insist on risk > control> and we are now seeing them refuse patients until the cardiac > situation has been> clarified and there is a note by cardiology that it is OK to > proceed. Even so,> many times the vasculopath will still have something underneath the > surface.> > In my hospital, one of the general surgeons had a death on the table > from> acute MI during a carotid (before the carotid was even clamped). This> patient also had a negative preop thallium. This case still haunts > him...> > There was a malpractice case in my state (not at my hospital) decided > against> the surgeon for a death from MI after a carotid...for "failure to > diagnose".> > This is the playing field we are on. Even with some papers saying > there is no> difference between groups, there is a difference if something happens > to your patient> and the critics ask you why you did not investigate. It is very, > very hard to explain> a statistical analysis of comparative groups to a jury. Forget > it. They just> want to know if you did everything you could to make the operation > safe. If not....> > I continue to request cardiology screening, cath, and/or > interventions for symptomatic> patients or those with high risk factors, EKG findings, etc. prior to > undergoing> a major vascular case.> > Mark> > > > Mark M. Levinson, MD> Founder, Editor-in-Chief,> The Heart Surgery Forum> WWW: <http://www.hsforum.com>> Email: <mmLevinson at hsforum.com>> > > > _______________________________________________> 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> -----------------------------------------