What do We do when Our Parents or Family Members Need an Invasive Procedure- Do we su

[surgblumm]

When Our Parents or Loved Ones Need Invasive Procedures-What’s Our role?

Bob Blumm, MA, PA-C, DFAAPA

Mom has a cardiac history, HCM and A-Fib as well as some CAD and is short of breath on climbing a flight of stairs and doing general ambulation to a store (few blocks.) Obviously she needs a cardiac cath but the questions that surface will be other than stents would you agree with a treatment plan for a CABG at this age with a history of respiratory problems. She is presently active, enjoys life with restrictions and is otherwise OK

3 million cardiac catheterizations are performed annually in the USA. Indications are obviously CAD, SOB, acute MI, and interventions such as angioplasty with stents. But what are the inherent risks? Risks of this procedure consist of localized bleeding and hematoma, retroperitoneal bleeding, CVA, perforation and death. The percentage is small but when these are our family members percentages are even more meaningful July is Resident and Fellow month and as a provider I only want an experienced cardiologist.

When we think of those at risk we consider those of advanced age such as 70 and even more so at age 80. Females may be the stronger sex but are more vulnerable in these cases. We need to consider allergy, particularly to dyes utilized during the procedure which can lead to renal failure or at least complications a cause of iatrogenic injury and the obvious history of comorbidities. History of previous procedures utilizing the femoral artery can So do we encourage a procedure with possible or potential problems or do we suggest following through to the point of understanding if angioplasty and stents will offer relief but draw a line at CABG, that’s the crux. Iatrogenic injuries. There is an expected period of time that is not standard across the country which includes four hour ambulatory stays where a trained nurse is looking for complications and reading focused vital signs and then there are those institutions that take an elderly population and make them a 23 hour stay. Most cardiologists will take their patients off Coumadin if they have A-Fib anywhere from day 3 to 5. Bleeding and occlusion are the usual complications probably followed by stroke of organ failure from the dye. Nothing is without potential complication therefore how would you as a PA/NP approach this in your family?

Regards,

Bob

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