Amyloid

Started by PpfSuxTube
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PpfSuxTube

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Patient coming for elective operation.
Recent diagnosis of amyloid from skin biopsy, smoker some sob.
Only has tte showing hypertrophy of septum. No cardiac mri or genetics completed.
How do you clear this patient for their procedure? Do they have to have mri/cardiologist clearance?
 
At first thought, I'd say if >4 METS, no chest pains or shortness of breath, then full send. Obviously the size and seriousness of the elective procedure may shift that approach, but I think their functional status would determine most.

Admittedly, I don't remember a lot about amyloid heart disease so I'd do some reading before actually giving the green light to make sure I'm not missing something.
 
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Procedure matters.

There is 1) truly elective “breast augmentation” vs 2) kinda elective “cholecystectomy” (due to recurrent symptomatic episodes) vs 3) elective but not really elective “partial colon resection” (curative intent for known colon cancer)

And is this procedure something take can be done under regional + sedation?
 
If it's an elective procedure, you can hang your hat on functional status. Cancer or non elective is a go to me outside of rare circumstances regardless. Nothing much to be one to optimize these patients further.
 
Why do you think because they have amyloidosis on a skin bx they have cardiac amyloidosis? Do you know the form of amyloidosis? Do they have hx of heart failure or dysthymia? If it is truly elective then may be best to obtain an MRI and have cards give their blessing. If the case is urgent or emergent then I would probably proceed without further testing based on hx and functional status.
 
Elective lap double hernia. Hasn't even seen cards yet. Just a 2 yr old echo with some sob as symptoms. Sedentary on narcs for pain so who knows.

I didnt actually cancel them and was considering passing them, but I did contact the surgeon who knew nothing of it and he immediately canceled it without asking me anything really
 
PainDrain said:
Why do you think because they have amyloidosis on a skin bx they have cardiac amyloidosis? Do you know the form of amyloidosis? Do they have hx of heart failure or dysthymia? If it is truly elective then may be best to obtain an MRI and have cards give their blessing. If the case is urgent or emergent then I would probably proceed without further testing based on hx and functional status.
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Ttr
 
I would repeat echo and go from there since excercise tolerance is unknown. If much the same then go for it, if terrible diastology then decline. And make sure ECG doesn’t look high risk for periop heart block
 
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