In Memoriam – Dr. Ali Massumi

by | Mar 19, 2015 | Personal

This week, a dear friend and mentor, Dr. Ali Massumi, died from a long battle with cancer.   Dr. Massumi was a giant in Electrophysiology at the Texas Heart Institute and his impact on the field and over 200 trainees was immense.  He will be sorely missed by all of us, and his legacy will live on in our hearts and in our daily practice of...

Perioperative Guidelines 2014 Update – Synopsis

by | 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...