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- Jan 17, 2009
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I work at four different hospitals in a major metro area. In all of them, our cardiologists (several different groups spread across the city) are generally resistant to urgent (non-STEMI) caths.
To illustrate an example of this... Elderly gentleman w/ history of CAD arrives w/ sinus bradycardia and 'upset stomach'. EKG shows lateral depressions and concerning ST segment morphology in the inferior leads. Negative R-sided EKG. No criteria for STEMI. No active chest pain, just some intermittent bradycardia, previously mentioned 'upset stomach' has resolved. High-sensitivity trop comes back significantly elevated. I speak with cardiology (at 10pm). ''This guy should go for urgent cath", I say. "No" is invariably the answer. Every. single.time. "Heparin and admit", they say. Then they dick around with nonsense like Lexiscans and repeat trops for a day or two.
I have seen this scenario play out literally dozens of times. It's rare that the cardiologist says "yeah, you're right, this is really concerning, let's just take him to cath now", even though that is nearly without a doubt the correct next step in almost every instance. This especially puzzles me as I thought caths were the big money-makers for these guys. It seems that there should be no lack of enthusiasm for doing as many urgent and semi-urgent caths as possible.
Don't get me wrong, I will activate the cath lab over a cardiologist's objections all day long if I feel it necessary, but I happen to run into the situation mentioned above far more often. I know this isn't isolated to my practice environment. Any one have any idea what these guys are thinking?
To illustrate an example of this... Elderly gentleman w/ history of CAD arrives w/ sinus bradycardia and 'upset stomach'. EKG shows lateral depressions and concerning ST segment morphology in the inferior leads. Negative R-sided EKG. No criteria for STEMI. No active chest pain, just some intermittent bradycardia, previously mentioned 'upset stomach' has resolved. High-sensitivity trop comes back significantly elevated. I speak with cardiology (at 10pm). ''This guy should go for urgent cath", I say. "No" is invariably the answer. Every. single.time. "Heparin and admit", they say. Then they dick around with nonsense like Lexiscans and repeat trops for a day or two.
I have seen this scenario play out literally dozens of times. It's rare that the cardiologist says "yeah, you're right, this is really concerning, let's just take him to cath now", even though that is nearly without a doubt the correct next step in almost every instance. This especially puzzles me as I thought caths were the big money-makers for these guys. It seems that there should be no lack of enthusiasm for doing as many urgent and semi-urgent caths as possible.
Don't get me wrong, I will activate the cath lab over a cardiologist's objections all day long if I feel it necessary, but I happen to run into the situation mentioned above far more often. I know this isn't isolated to my practice environment. Any one have any idea what these guys are thinking?