General Medical issues thread

[Quickstatus]

Interesting though i do not see it offered on local hospital cardiac websites.

Not mainstream yet and as I i understand, it is a niche offering. only some patients are suitable - if you can find a cardiologist that offers it.

 

[prozac]

Not mainstream yet and as I i understand, it is a niche offering. only some patients are suitable - if you can find a cardiologist that offers it.

It seems it is a last ditch effort procedure. I would have thought you'd have pieces of plaque flying through the blood to give you a quick stroke somewhere. The explanation says not and pieces very small. Just wanting to stay informed.

 

[Quickstatus]

Not a topic I suspect I can broach successfully.

The Sestamibi heart scan and other investigations is only to determine medical suitability for surgery and anaesthetic.

Surgery only puts a new knee joint in, but the outcome of a TKR is not that a new joint is put in. It is what happens to the knee function after a new knee joint is put in. When a knee deteriorates, the muscles that move the knee get used less so they atrophy. Once a new knee is put in the muscles don't magically go back to normal. Anything that can be done to improve the muscles before hand only improves the TKR outcomes.

It is also well known that High BMI is associated with poorer outcomes after a TKR.
Its hard enough to be back on your feet the day of or day after a TKR (which is the immediate goal after a TKR) let alone while carrying extra 40-50kg on your back doing so.

Therefore "Prehab" is as important as Rehab.
Outcomes can be quite positive and life changing but there is a lot to do between now and March to get there. At least there is some time.
Father needs to get his leg muscles as strong as possible and optimise his medical issues, lose weight prior to surgery in order to gain the best outcome possible.

 

[drron]

Not a topic I suspect I can broach successfully.

Which is sad because it is the most effective way of getting a better result from surgery. In fact in some cases the outcome is surgery is no longer needed.

Just wondering if there has been any advancements in angioplasty procedures past few years. Someone suggested to me recently that arterial plaque could be physically removed. I was skeptical (very).

When angioplasty was first done stents had not been invented and it was balloon angioplasty. In 1992 I had the privilege of looking after the first ever proceedure done in 1962 at St. Vincents hospital Sydney in 1962. He obviously survived and had no cardiac events since. He had a negative sestamibi test. his Cardiologist though had died.

 

[tgh]

Rotational coronary arthrectomy.. is the reason I am still here...

 

[prozac]

Rotational coronary arthrectomy.. is the reason I am still here...

Heart or limb? Did they stent afterwards?

 

[andye]

It seems it is a last ditch effort procedure. I would have thought you'd have pieces of plaque flying through the blood to give you a quick stroke somewhere. The explanation says not and pieces very small. Just wanting to stay informed.

Its been knocking around for about 20 years but yes uncommon probably as need high technical skill level. Stroke risk shouldn't be higher than other interventions unless the lesion is at origin of coronary artery. Main complication issues are dissection or perforation of coronary artery

Here is an (oldish) European overview

European expert consensus on rotational atherectomy

European expert consensus on a standardized protocol for performing rotational atherectomy to treat heavily calcified coronary lesions.

eurointervention.pcronline.com

 

[tgh]

Heart or limb? Did they stent afterwards?

Heavily calcified lad , all in one spot….. rotablator + stent
No heart attack , just raised bp that sent me to seek help , back to normal bp and fit as a mallee bull to boot…..

 

[Quickstatus]

you'd have pieces of plaque flying through the blood to give you a quick stroke somewhere.

worst is a dissection (split in the coronary wall causing a collapse and blockage). The bits of drilled material is very small

 

[tgh]

worst is a dissection

..leads to..
Opine that rotablation should take place in the best full service cardiac facility one can find.
Yes the procedure has stellar results but if the excreta hits the revolving object.. open heart surgery may be moments away….
I might say that all this wisdom comes from hindsight and I did not really have a clue in the heat of the moment.

 

[Quickstatus]

rotablation

And stenting for that matter, though so think the risk would be lower (but not zero) for standard stenting

 

[tgh]

Interesting that such complex procedure has such a stellar success rate, who remembers the first heart transplant ?

The first human heart transplant and further advances in cardiac transplantation at Groote Schuur Hospital and the University of Cape Town - PMC

 

[prozac]

worst is a dissection (split in the coronary wall causing a collapse and blockage).

I've had a dissected LAD and can vouch for discomfort level.

The bits of drilled material is very small

Understood this when I read up on it. My comment was my preconception that bits might travel.

 

[Quickstatus]

bits might travel

Too small to cause issues - apparently...