[NP-Clinical] Cardiac Questions

[C. Minch & J. Wildauer]

Did he receive medical clearance for surgery?  At 70 yo this would be 
routine where I live.
Jean
----- Original Message ----- 
From: "Joyce Fontana" <jfontana at frontier.net>
To: "NP Clinical" <np-clinical at nurse.net>
Sent: Friday, February 16, 2007 4:13 PM
Subject: Re: [NP-Clinical] Cardiac Questions


> 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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