[NP-Clinical] Cardiac Questions

[Joyce Fontana]

No perioperative beta-blocker? Pretty standard now, unless maybe 
contraindicated by the COPD?
Just a thought.

Joyce
----- Original Message ----- 
From: "Christine Smith" <chrisbsmith at mindspring.com>
To: <np-clinical at nurse.net>; <ACC-Circle at listserve.com>
Sent: Wednesday, February 14, 2007 4:36 PM
Subject: [NP-Clinical] Cardiac Questions


Need some cardiac thoughts please....

70 yo friend went in for some colon polyp removals. Was told it was 
elective, did not have to occur but advised. Ended up coming out with 
incision from xyphoid to low abd with gall bladder taken out and partial 
colectomy. "just took the gall bladder out to prevent future problems". 
Uneventful hospital course except significant pain that he did not express 
real well to staff and MD. Dc'd home nauseated but taking PO. Came back 3 
hours later dead.

PMH - COPD, Old Prostate CA now in remission. Had a Stress test and Echo in 
September which was good "benign ventricular ectopy" and Ejection Fraction 
of 53%. CXR and a CT scan of the chest done in Sept ((chest pain, R/O PE 
episode) was negative. Never any documentation of LVH on 12 leads, CXR or 
anywhere else. Not on any meds, no hx of HTN. Got regular health care. COPD 
was so controlled not even on meds. Still smoked less than 1 PPD. Patient 
was very active, retired and fit.

Reviewed the autopsy report yesterday with family - coroner states he died 
of LVH. All the other findings were benign - lungs showed some adhesions, as 
did abdomen, and some sclerosis to the kidneys. No infarction.

So, can LVH never be diagnosed previously? Is that the sole reason for his 
death? Family very upset - PCP refuses to talk to them or explain anything. 
He did not even offer condolescences.

Patient came home from the hospital, told his wife "I am not going to make 
it". She thought it was his pain that made him like that. She reassured him. 
Three hours later he collapsed in his chair and said call 911 and the kids. 
10 minutes later, still waiting for 911, his wife told him the kids were 
there. He immediately went unconscious. Enroute and initially at the ER he 
was in a rapid Afib and unconscious. Shortly after arrival, despite repeated 
cardioversion enroute and in ER, he went into asystole and died.

He only was on Vicodin when he left the hospital. Prior to that he was on IV 
abx.

Thoughts? Family is still in shock and close friends of mine.

Christine Smith, NP




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