83yo male for cystoscopy and stent exchange due to chronic obstruction from uroepithelial carcinoma.
- Uroepithelial carcinoma
- Impaired glucose tolerance
- AF. On apixaban.
- PPM for CHB (99% paced, underlying AF).
- Recent PCI
- Type 2 MI Post-operatively after stent insertion
- Ongoing intermittent chest pain last 6/12
- PCI + rotablation for severe ostial RCA stenosis. 3/52 ago
- For lifelong clopidogrel and apixaban.
- Ureteric stent now 7/12 old, urologists keen ++ to replace
Ideal timing of surgery?
- Discussed with treating cardiologist: happy to proceed 4-6 weeks post-PCI
- Requests to continue clopidogrel perioperatively.
- Discussed with surgeon – happy with plan
Communication in the perioperative clinic
- Much time spent attempting to phone proceduralists and clinicians, they are often busy/scrubbed and then call back when we are with another patient
- Email often a more effective tool – ability to CC all relevant clinicians and the HNELHD-JHHPeriopnurse@health.nsw.gov.au perioperative nurse address.
- Provides a paper-trail of communication. Encourages multidisciplinary engagement.
- Clinician email addresses usually available on their letterhead/website.
- The urology registrars are setting up an email address to allow us to create a bank of patients for them to ask their consultants about on a regular basis.
Cardiac Investigations in this patient post initial Type 2 MI
- Interestingly this patient had a sestamibi which showed ‘no major area of inducible ischaemia’ and that patient had no chest pain throughout the protocol.
- Note that the stress ECG component of the test is difficult to interpret in the present of Ventricular-pacing.
- See article on non-invasive cardiac stress testing (http://dx.doi.org/10.1136/heartjnl-2015-307764).)