Hairy Situation

[CVSURN]

Hello,

I am a CVSU RN in a small hospital with about 11 beds in our unit. We have two heart surgeons who pretty much do it all, including the pulmonary, GI, and renal stuff. Very rarely do they like to consult another doctor.

I have an RN friend who works on the unit with me, and her 50 year old father just found out he had a heart attack, and his ejection fraction is only 15%. He has had no symptoms at all. He quit smoking two weeks before he found out. He was chewing on a nicorette gum one day, and passed out. He had the workup, echo, cath, etc. Her father has severe multi vessel disease, with a 100% occlusion of his LAD, and 3 separate 80-90% occlusions of his RCA. He had good collaterals off of his RCA which is probably why he is still alive. They refused to to PTCA on him, and they've refused to operate on him for now. They want to treat him medically, and then MIGHT operate on him in a few weeks when his heart is stronger. Again I reiterate he has had no symptoms. He does have a few risk factors:smoker, hi cholesterol, familial history. He's a great man.

Just wondering if anyone had any new ideas on what can be done for him besides an operation? Should we take a chance and have someone PTCA that LAD?

On our unit, as I said the surgeons do it all. It is a small hospital. We don't use an intensivist for any of the medical care. the surgeons do it. They're always reluctant to consult another doctor. Sometimes it has devastating results. Should her father go to another facility for an operation if needed?

Anybody feel indifferent about having heart surgery at a smaller facility? Also we both work there, and it would be extremely difficult for either one of us to take care of him. This is a whole other situation. How would you feel about taking care of a very critically ill father of a friend and co-worker? Personally I don't want to do it, but I feel i may have to.

My friend is also angry at her father for treating himself badly all these years because now he may die and leave them alone. She just doesn't know how to express that anger. What would you tell her?

Thank you in advance. I just wanted to get the advice of some other nurses out there. I am new to the board. Thanks a lot.

CVSU RN

[chaosRN, ASN, RN]

With a 100% occluded LAD & with his RCA partially occluded, does he have 3-4 weeks to wait? A 50yo is too young too have so much collateral circulation that it bypasses the LAD. I agree with the others, you may want too seek another opinion. I was also thinking about the IABP too. He could stay on the IABP 1-2 days, do an ECHO to see if the heart is stronger with it, PTCA & possibly CABG.

I wish you, your friend & her father all the best with this & pray for a quick recovery. Let us know how it goes! :)

[rjflyn, ASN, RN]

I wanted to all something to this thread as well. SHe noted that he has a EF of 15%. The importance of doing something sooner rather than later is the therory of stunned myocardium, that some of the heart muscle is not dead just not functioning as it should due to lack of blood flow. I've acctually seen pts with EF this low recover a significant portion of LV function after having blockages open- abeit this is risky but so is being 50 with a occluded LAD. The other thing to also remember is that a siginificant portion of the population is RCA dominate and that tx the right blockages may improve things as well.

Rj