by Mark | Mar 14, 2015 | Cardiology
Perioperative Guidelines 2014 Update – Synopsis Wait ≥ 60 days after MI prior to non cardiac surgery in the absence of coronary intervention. Age > 62 yo is an independent risk factor for perioperative stroke. Perioperative Valvular Disease Considerations: Patients with moderate-severe stenosis or regurgitation need an echo if none in the last year or changes in clinical status or physical exam. In patients that meet indications for valvular surgery, valvular intervention (replacement/repair) reduces perioperative risk. Asymptomatic severe AS may receive elective non-cardiac surgery (elevated risk). Asymptomatic severe MS may receive elective non-cardiac surgery (elevated risk), if balloon MV-plasty not possible. Asymptomatic severe AI with normal LVEF may receive elective non-cardiac surgery (elevated risk) Asymptomatic severe MR may receive elective non-cardiac surgery (elevated risk) ICD management plan should be discussed between surgeon and “clinician” prior to non-cardiac surgery. Patients with pulmonary HTN should have PH specialist, and should continue usual pulmonary vascular therapy. Pre-Surgical Cardiac Testing: Go to surgery: surgical emergency, low-risk surgery (< 1%), > 4 METS. Stress testing: < 4 METS, unknown functional capacity. Not useful for low risk surgery or > 4 METS. EKG: useful for CAD, arrhythmias, PAD, cerebrovascular disease, structural HD. Not useful for low-risk surgery & asymptomatic. LVEF: unknown dyspnea on exertion, HF with change of symptoms, HF with no echo for 1 year. Not useful for routine use. Cardiopulmonary Testing: elevated risk surgery & unknown functional capacity. Coronary Angiography: routine use not needed. Ok to revascularize if it is indicated anyways. Post-PCI Recommendations to Delay Surgery: Balloon angiography: 2 weeks Bare metal stent: 1 month DES / DAPT: 1 year...
by Mark | Dec 24, 2014 | Personal
Merry Christmas to everyone ! I am just now getting over the flu, but to stay positive I am thinking about what I’m most thankful for this Holiday season: my wife and kids, my parents/in-laws, and many friends who make life joyful and not “so serious.” Also a special thank you to Mr. Magne who has been a great mentor and friend and who has helped me establish my career. To all who read this, may your Christmas be bright and best wishes for...
by Mark | Nov 19, 2014 | Cardiac Electrophysiology
Ok so this is my first foray in to blogging. I’ve been thinking about getting online for years but due to the busy nature of my work as a cardiac electrophysiologist, I have delayed getting into writing online until now. What has really motivated me to start a website and blog is that I want a way to meaningfully connect with my patients, and also a forum to discuss the latest developments both in science and in clinical electrophysiology (EP). The goals of this blog are to make the concepts and study of EP accessible to others and to generate discussion about heart disease and arrhythmias in a meaningful way. Of note, this website is for educational and entertainment purposes, does not constitute medical advice, and does NOT imply a doctor-patient relationship. Over the next month or so, I will be slowly putting together the look and “feel” of the website, as well as developing themes for discussion. Stay tuned for more changes soon...
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