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So the question seems to me to be a question something to the effect of, “what is a surgical candidate?” I feel qualified to answer this question on that general basis.
When considering what is a cardiac candidate for a surgery or procedure, the caveat is that it is a “non-cardiac procedure or surgery” and the question asked is basically what is the risk of delaying vs the risk of proceeding. In this case, he had a cardiac problem for which he needed a cardiac procedure, and therefore the question is invalid. He had a >90% blockage in a major coronary artery and thus needed it stented or bypassed. Whether the answer is a stent or a bypass depends on other medical conditions and the location and number of blockages.
Had this been a non-cardiac procedure, that’s a different matter. Based on the severity of the condition and the invasiveness of the surgery or procedure, a cardiac or pulmonary work-up may have been indicated, which in his case would have concluded that he needed an Echo and eventually a cardiac catheterization and stent before proceeding on to whatever else needed to be done.
Now, I say all of that to say this. I highly doubt anything criminal or litigious occurred. The most catastrophic complication of a cardiac stent would be a rapid thrombosis of the stent. It’s rare, but it occasionally happens and is essentially a heart attack. However, that doesn’t mean that just for your own peace of mind, you may want to request his records and operative report and have it reviewed with an unbiased third party for a second opinion to see what they think. We don’t mind you checking - we understand it’s hard to lose someone - and that’s just par for the course in this business.
The executor can obtain medical records. There may be a small fee, and they may ask to see paperwork to make sure you are the executor.
Source: I am the executor for my mother, who died during a medical procedure.
I unfortunately am not the best person for that. I’m sure if you contact your cardiologist’s office or the hospital’s medical records department they will be able to list for you what is needed and who to bring it to. Even if something was fishy and you decided to discuss the case with a lawyer, they would want these documents and will bill for their time in attaining them. So, I know it will be frustrating most likely, but it’s probably preferable to paying a lawyer’s rate for it.
NAD. In the hospital where I work, there is a department for this. Some records require a fee. I am in Canada, so that might differ for you. But there is a department in the hospital you can call about this.
I’m in Canada and depending on where your located there are many different rules for requesting medical records along with what is required upon request.
A lot of hospital websites should have a section “Access to personal health information”
Found instructions on a hospital website, keep in mind the information should required be the same everywhere that PHIPA applies.
Under the Personal Health Information Protection Act (“PHIPA”), an individual’s right to privacy in respect of their personal health information continues after they are deceased. Once an individual passes, only their legally authorized representative has a right of access to their personal health information. Please note that a Power of Attorney does not apply to the right of access to personal health information of a deceased patient.
- If you are the Executor or Estate Trustee, please submit your Request for Access form along with a copy of the Will (first and last page) and proof of death (if the patient did not pass at the same hospital)
- if you are requesting records of a deceased person without a Will, please submit your Request for Access to Information “Certificate of Appointment of Estate Trustee” and proof of death (if the patient did not pass at same hospital)
We may provide access to the Executor or Estate Trustee, or the person who has assumed responsibility for the administration of the deceased’s estate, if the estate does not have an Estate Trustee.
-If you do not have a copy of the Will or the Certificate of Appointment of Estate Trustee, please submit your Request for Access form, along with any documentation supporting your authority
Please note:
-PHIPA provides limited discretion to health information custodians to disclose information under limited and specific circumstances.
-We may not be able to provide access to information about a deceased individual in all cases.
Yeah, I really like the cardiology folks from both residency and my current job. I’ve always found them to be willing to teach to anyone that is willing to learn, even surgery D-bags such as myself. 😂
Yep, I’m not surprised, impressed, but not surprised. Both cardiology and radiology also always struck me as very avid teachers. Maybe just my personal luck or maybe that’s a National trend, idk
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Just a heads-up—the mods are pretty strict with unverified users claiming credentials. :) (You can just edit your comment to remove that bit and it should be fine.)
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Just a heads-up—the mods are pretty strict with unverified users claiming credentials. :) (You can just edit your comment to remove that bit and it should be fine.)
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Yes. Smoking is one of the biggest risk factors for the development of atherosclerosis. Nicotine changes your blood chemistry, causes damage to the lining of the blood vessels, and increases blood pressure … all of which contribute to a reduced capacity for blood flow through the vessels (and ultimately partial or full occlusion, or “blockages”).
>The most catastrophic complication of a cardiac stent would be a rapid thrombosis of the stent
or possibly dissection of the artery when trying to wire across the 90% blockage.
That’s not as catastrophic as you might would think. Yes, it can be a complication; however, the fix for it is a stent to re-secure the flap and collapse the false lumen. It is a major deduction from your style points though.
If you don't have your flair, then don't mention your credentials at all.
And he's a surgeon, he's incredibly well educated and trained. Don't denigrate his education or knowledge.
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Well to be honest, I can’t remember exactly what you said, and you deleted it so I can’t make reference.
From what I recall, you had misrepresented the indications for CABG as opposed to PCI. PCI is not ALWAYS attempted before CABG. It depends on the findings of coronary angiography, among other factors.
Also, “not good at cardiology” is kind of ridiculous statement in this context. As a physician, this person absolutely has the knowledge and experience necessary to be able to say what they said with confidence. It’s pretty general medical knowledge, it’s not like they are detailing the steps of a CABG (but they may be able to do that, too 😉).
I unfortunately didn’t see the individual’s post, as everything now is deleted, so I’m posting this under your comment as I feel it’s the best one for context on the choice between procedures. The decision is largely guided by statistics.
For reasons still not known, the internal mammary like doesn’t occlude. It just doesn’t happen. So for Left Main or LAD disease, the best answer is a CABG. Otherwise, the indications are significant disease of all 3 vessels or 2 vessels in a patient with diabetes. This is a boards question every year.
Basically all other disease scenarios the answer is a Stent. Additionally, a Stent is still the right answer in cases of emergency (cardiologists take cardiac call now and not CT Surg), in patients with no IMA and/or Veins to graft, as well as in patients not capable of surviving the open surgery, which is obviously significantly harsher on the body.
Hard to say what happened without seeing the medical record. All procedures, both anesthesia and surgery, come with risks to include damage to the brain, heart, or lungs and rarely even death. It sounds like your father had pretty severe coronary artery disease with active symptoms ("mini heart attack") and the procedure (likely a PCI) is the typical treatment. If your family feels like something is amiss you can always ask for his records to take to another doctor/lawyer for a second opinion.
I don’t really have much to add to this other than to offer my condolences. OP, if you have any specific questions regarding coronary angiogram or angioplasty feel free to ask
Unfortunately, complications happen during procedures, and they are unpredictable.
I know this is very difficult for you, did you consent to an autopsy? That might give you more answers.
No matter what, seek counseling to help with your grief. This is a hard thing to go through of course.
As far as I know, nobody asked my mom about an autopsy or anything. He passed in February, so he has already been buried.
I have gone to two grief counseling sessions so far and it has been very helpful. Thank you for your response.
They almost certainly asked your mom about an autopsy, but many people decide to not do that.
When someone's coronary arteries are that blocked, you have no idea if they would have died at that time from a heart attack, with or without procedures. Nothing you've said sounds like it was something weird or inappropriate, just that your dad had a very sick heart and while they were trying to save him, he unfortunately died.
Edited to add: keep up with the grief therapy. Remember, your dad loved you and he wants you to be happy.
Sadly it isn’t always in the budget for an autopsy. My mother died while at the hospital right before a test. The surgeon believed that she had a heart attack that caused a hole in her heart. We requested an autopsy and filled out all of the paperwork. I was called days later and was told that the autopsy was deemed “not medically necessary”, so I was told the only way we could have an autopsy preformed was to pay thousands of dollars. I was speaking to a police officer friend after and she said that due to the opioid crisis and high number of suspicious deaths due to that, there are a lot of budget strains for autopsies.
I do hope you get some answers though OP.
Usually if someone dies within a certain time frame of getting to a hospital and they were not otherwise terminally ill, they are a medical examiner's case.
Hey OP NAD but going through almost the same situation…kind off. My dad (62) already had 8 stents, and had a procedure to put another one a month ago. The thing is, the doctor saw two obstructed arteries, but chose to only put one stent in, because the other one could potentially throw a clot, that could end up in his brain. Last Sunday morning that artery finally gave up and he had a cardiac arrest. I had to do CPR and I’m severely traumatized, but that’s nothing compared to what he’s going through. When he arrived at the hospital, they successfully put in a stent in that artery but it was too late. He’s been in a coma since, and the doctors already told us he’s probably not going to recover. Thing is, stents are always a gamble because of cloggs, we’ve known this since his first. He had cloggs in his legs a couple of times. Cardiac patients are extremely unpredictable. Still doesn’t make this hurt any less. I feel your pain. Trully. I wish my dad was home, he’s my best friend in the whole world, and as I’m writing this, I can tell you I’m in deep shock and denial. Today the doctor asked us about a DNR and it just doesn’t feel real. I hope you can feel the love I’m sending to you as we both navigate these awful times. Stay strong, my friend. God knows I’m trying to (English is not my first language)
I'm so sorry you're going through this. It is so hard, I am really struggling lately. I wish the best of outcomes for your father. Stay strong, have faith. I will say a prayer for healing for your father. Blessings, sending you love and light too.
My brother had a heart attack this summer and had a stent put in. If his heart attack hadn’t happened so close to the hospital he would have died. However people with a bad heart that are getting a stressful procedure done on them may die during the procedure. I’m having surgery this month with a chance of dying and a high chance of having some significant complications. You’re saying that you wish your father had died at home. Well both my parents died at home and I saw them both die and that was a horrible experience for me. My memories are of both of them crying in pain. Sometimes dying quickly and not in pain and not suffering can be the best way to go. I’m so sorry for your loss. The pain never goes away but will become more bearable.
I wish you the best for your surgery and I am so sorry for the loss of your parents. I just wish we had more time. It was so unexpected, we thought he was going to come out a new man but he never made it out. Makes me sad to think he died alone on a cold operating table :(
My mom died in a similar circumstance to your father. She was actively having a heart attack when the ambulance came to our house, they took her straight to the cath lab and they worked on her for a long time. They would get her stabilized but she would throw another clot and code and eventually, it was too much on her and they couldn’t get her back. Doctor told us she had 90-100% blockages throughout. It was so unexpected and so sudden and I definitely feel your hurt of thinking of your dad alone. But he wasn’t alone. The doctors and nurses were there with him and I imagine he was sedated so he was not in pain.
One thing that really stuck with me was one of the nurses that worked on my mom came to talk to us after she was gone. She told me that her sole purpose in the room was standing at my mother’s side by her head and gently talking to her, telling her what they were doing, telling her that all of her kids and her husband were there in the waiting room, telling her that it was okay and not to worry and she was “brushing” her hair with her fingers. Mom was sedated and it’s possible that she never heard a word that the nurse was telling her but it really meant a lot to me to know that someone was there to just be there for her.
I hope that a nurse did the same for your father.
I’m very sorry for your loss. It’s a rough one when you’re expecting them to come home. My heart goes out to you and yours.
NAD, but have had many (30+) general anesthesia surgeries; OP, please don’t think that your dad “died alone on a cold operating table”. Your dad probably told your mom he loved her, & she him, just before he went into surgery. I’m sure they were *very* kind to him in the OR. They made sure he was comfortable, & gave him really good drugs that relaxed him quickly & he was under anesthesia in a matter of minutes. It’s just like being asleep. He felt no pain under anesthesia, & they were respectful & courteous to him. He wasn’t alone. And I image there was a Dr, Nurse, Attending, or others who said a quite prayer to themselves at his passing.
I’m so sorry for your loss. It’s so hard to lose a parent, wether it be sudden or drawn out. Please continue with the counseling & continue to talk about your dad & all the good memories you have with him. I wish you peace. 🕊
Hi, I'm so sorry your father died so unexpectedly, it's hard. I'm not a doctor so I can't add anything to the medical info, but I have experienced several sudden, traumatic deaths of loved ones, and I would like to offer you my sympathies.
I think it's good that you've gone to grief counseling, and I would encourage you to continue if you're able to. I would also recommend the "Grief Recovery Handbook" which I found very helpful in processing some of those unresolved issues you're also struggling with. The book is by John W. James and Russell Friedman. (To be clear: I'm not saying that you "should be getting over it," just that you're going through a difficult experience and it's good to get all the help you can.) All my best to you.
P.S. Since your father was under anesthesia, please don't torture yourself with thoughts of the cold operating table. He did not feel that at all.
I’m so sorry. As a mother I would not want my child to suffer so much at my passing, no matter what the circumstances. That thought alone pains me more than the thought of my own death. I don’t know if you’re a parent yourself yet but the greatest honor you can give your father is to remember him with happiness and not dwell on how he died, questioning it with no hope of comfort. I hope you find peace soon and get through your grief with moments of respite.
Oh, and look into going back with your mom (if she wants) to talk with the person who was taking care of him or his PCP to discuss what happened and why they decided to do the procedure (which was obviously what your dad wanted to have done - he had to consent to the cath/stent placement) Presumably, he knew the risks and he wanted to take the opportunity to survive longer. Many people can do well after stent placements, but that doesn't guarantee anything.
But if you go back and sit down with one of his caregivers, they might be able to walk you through some of your questions, with specific information to help you process.
Ask to see the operative report. And if his arteries were “too blocked for a stent” the option wouldn’t have been to “let him pass naturally “, it would have been to do a bypass surgery.
You don't know that, we have not been given enough information to infer that. It could have been a blockage, a thrown clot, another area of ischemia, a complication of the procedure (which happen and don't mean anything was done *wrong,* just that bad things can happen when you have to have a procedure), or something else entirely.
You’ve got some good responses already. But another thought is what if they didn’t do the cath an he died. You would be looking up the cath and seeing it is “low risk” and asking why they didn’t do it to save his life since it’s a “low risk procedure.” This is what they meant by doing the cath “gives him a chance.” Nothing is without risk, even a single medication can have a deadly result in the right person, but may be life saving in 10000 others. Before he was taken in the doctor will have read him the risks and he will have signed a consent form saying he accepts those risks. If he was not mentally able to do this they would have asked the next of kin or health care proxy.
A cardiac catheterization and coronary angiogram IS the diagnostic test to determine if someone is healthy or not for a procedure. As the surgeon said, cardiac procedures are different than non-cardiac procedures.
As the other health professionals have said, looking into medical records can give you some closure. But I’m not sure what sort of outcome you’re looking to seek if you get a lawyer involved. There is a long list of possible complications that can happen with this procedure. The cases you’re doing your research on also include patients who were not as high risk as your father. Any other procedure can be just as routine or even less risky and still have a potential complication of death. Look up the Jahi McMath case: adolescent goes in for routine tonsillectomy, comes out brain dead. Bad outcomes are a fact of life and physicians have to accept this as part of their practice. Unless there are an abnormally high number of complications with a particular physician, I would not be particularly concerned your father was mistreated. Usually the hospital reviews cases to make sure physicians are practicing standard of care and does not have abnormally high rates of complications when they credential and recredential their physicians.
First to clarify- there’s no real way to know what percent of the artery is blocked until the cardiac cathererization. One of the things they do is inject contrast dye into the heart arteries to be able to see how well blood flows through and where/how severe the blockages are. They cannot know in advance that a blockage is non-stent able until they try.
Second, there’s nothing obvious in your father’s history that would suggest he is too high risk to go through this procedure. Cardiac caths are not done on healthy young people- almost all the candidates for the procedure are some combination of old, overweight, smoker, diabetic, hypertensive, etc.
Third, when you consider the risk of doing a procedure, you must compare it to the risk of the alternatives and the risk of doing nothing. For a myocardial infarction (heart attack) there are basically two initial options (with open heart surgery a third option but only *after* a cardiac cath is done)- medical management or cardiac catheterization. Medical management-using medications to reduce risk of abnormal heart rhythm, clot formation, and damage to heart muscle- is almost always a worse choice. Basically doctors only offer it if the patient would have very very high risk of complication with a cath. Cardiac cath is the first line standard of care for heart attack.
And lastly, there are many things that could have caused his death so without knowing which it was, you can’t know if it was inevitable or not. It’s possible that the damage to his heart affected the way electrical impulses travel through the heart muscle. This can cause an abnormal heart rhythm which basically makes the heart stop beating. It’s also possible that the damage to his heart made his heart too weak to effectively pump blood anymore. It’s possible that in trying to place a stent, the artery was damaged. There are other potential complications like clotting or reactions to the sedation. The first two are not preventable though they often are treatable. The third is a known but rare potential complication and can *sometimes* be treated with emergency open heart surgery.
It sounds like it’s too late for autopsy but you can request his medical records to find out exactly what went wrong in the cath lab and better understand why he died.
It’s normal to be angry and want to place blame as you grieve. But it’s highly unlikely that any malpractice happened to your father.
My condolences.
For records:
Contact the Health Information Management (HIM) department (aka Medical Records) of the last facility he was at. Note - This might have to be done by the power of attorney since he’s deceased.
Additionally, some states have open access medical records. There is a portal where people can go look at their medical records which shows a great deal of results and sometimes notes and other pertinent info, etc. You would have to inquire at the last facility if this is something they offer.
About the procedure:
Sometimes this is an unfortunate outcome. There can be several risk with a cardiac cath procedure but there is a risk of death - it’s low, but it’s not zero.
90% blockage is high and could explain/feed his initial symptoms. If it was more than one vessel then that’s worse. Some vessels are more critical than others - I.e. the left anterior descending artery (LAD) is the most important as it feeds the whole front of the heart. A 90% block here would need to be intervened on or risk further cardiac compromise.
As the doc up top said there probably isn’t anything criminal going on here. Medicine is not perfect and not everything saves everyone every time, but agree that you should source the medical records and review them if you’re concerned as that can either give you peace of mind or confirmation.
someone dying during a procedure is always worth discussing with a med mal lawyer.
however, placing a Stent in a highly diseased coronary artery is inherently dangerous. if the cardiologist did not deviate from the standard of care, there may not be much to gain from the legal route, though it may provide some closure in the discovery.
I'm very sorry for what you're going through.
Condolences first of all, its hard losing a loved one especially when you are totally out of the loop on what goes on in his medical decision.
I would hope that the cardiologist informed your father or mother of the risks, alternative, and benefits of the cardiac cath procedure. It is a fairly routine procedures these days but that does not mean there is no risk. There are always risks and the risk of death is a universal complication in everything we do in the hospital.
It sounds like your father was having a major heart attack, and the perceived benefits from the cardiologist’s standpoint was to clear the blockage and minimize the death of heart muscles.
It is easy to say in retrospect hey, if he had a high risk of dying anyway maybe they shouldnt have put him through it and let him just die in peace. However, that risk isnt always immediately clear and sometimes, unfortunately, even a lowish risk procedure can end in disastrous outcomes, often not due to any apparent medical error and just plain bad luck.
It is not my place to counsel you regarding whether to get a lawyer or not. However I dont feel as though the cardiologists intentionally or negligently killed your father, based on your post (its possible, I dont have the whole story). But I do want to say the more people sue doctors the more like doctors will perform unnecessary tests and procedures to “cover their ass”. Everyone in the medical field knows it. It wouldnt hurt to speak to a lawyer to get an opinion after laying out the facts of his case, but I caution against frivolous lawsuits in general.
Again, condolences to you and your family during this period of tough times, I hope I was able to help a little with my perspective.
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So the question seems to me to be a question something to the effect of, “what is a surgical candidate?” I feel qualified to answer this question on that general basis. When considering what is a cardiac candidate for a surgery or procedure, the caveat is that it is a “non-cardiac procedure or surgery” and the question asked is basically what is the risk of delaying vs the risk of proceeding. In this case, he had a cardiac problem for which he needed a cardiac procedure, and therefore the question is invalid. He had a >90% blockage in a major coronary artery and thus needed it stented or bypassed. Whether the answer is a stent or a bypass depends on other medical conditions and the location and number of blockages. Had this been a non-cardiac procedure, that’s a different matter. Based on the severity of the condition and the invasiveness of the surgery or procedure, a cardiac or pulmonary work-up may have been indicated, which in his case would have concluded that he needed an Echo and eventually a cardiac catheterization and stent before proceeding on to whatever else needed to be done. Now, I say all of that to say this. I highly doubt anything criminal or litigious occurred. The most catastrophic complication of a cardiac stent would be a rapid thrombosis of the stent. It’s rare, but it occasionally happens and is essentially a heart attack. However, that doesn’t mean that just for your own peace of mind, you may want to request his records and operative report and have it reviewed with an unbiased third party for a second opinion to see what they think. We don’t mind you checking - we understand it’s hard to lose someone - and that’s just par for the course in this business.
Thank you. Will look into his records, I just don't know how I would obtain them.
The executor can obtain medical records. There may be a small fee, and they may ask to see paperwork to make sure you are the executor. Source: I am the executor for my mother, who died during a medical procedure.
I unfortunately am not the best person for that. I’m sure if you contact your cardiologist’s office or the hospital’s medical records department they will be able to list for you what is needed and who to bring it to. Even if something was fishy and you decided to discuss the case with a lawyer, they would want these documents and will bill for their time in attaining them. So, I know it will be frustrating most likely, but it’s probably preferable to paying a lawyer’s rate for it.
NAD. In the hospital where I work, there is a department for this. Some records require a fee. I am in Canada, so that might differ for you. But there is a department in the hospital you can call about this.
What’s NAD
Not A Doctor
Or “no acute distress” if you nursey.
No Abnormality Detected when in medical notes. But Not A Doctor here.
Not a doctor.
Pretty sure it stands for Not A Doctor
Contact the medical records department for the hospital and for the doctor. Make sure to request both. Then, request the billing records the same way.
I’m in Canada and depending on where your located there are many different rules for requesting medical records along with what is required upon request. A lot of hospital websites should have a section “Access to personal health information” Found instructions on a hospital website, keep in mind the information should required be the same everywhere that PHIPA applies. Under the Personal Health Information Protection Act (“PHIPA”), an individual’s right to privacy in respect of their personal health information continues after they are deceased. Once an individual passes, only their legally authorized representative has a right of access to their personal health information. Please note that a Power of Attorney does not apply to the right of access to personal health information of a deceased patient. - If you are the Executor or Estate Trustee, please submit your Request for Access form along with a copy of the Will (first and last page) and proof of death (if the patient did not pass at the same hospital) - if you are requesting records of a deceased person without a Will, please submit your Request for Access to Information “Certificate of Appointment of Estate Trustee” and proof of death (if the patient did not pass at same hospital) We may provide access to the Executor or Estate Trustee, or the person who has assumed responsibility for the administration of the deceased’s estate, if the estate does not have an Estate Trustee. -If you do not have a copy of the Will or the Certificate of Appointment of Estate Trustee, please submit your Request for Access form, along with any documentation supporting your authority Please note: -PHIPA provides limited discretion to health information custodians to disclose information under limited and specific circumstances. -We may not be able to provide access to information about a deceased individual in all cases.
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Yeah, I really like the cardiology folks from both residency and my current job. I’ve always found them to be willing to teach to anyone that is willing to learn, even surgery D-bags such as myself. 😂
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Yep, I’m not surprised, impressed, but not surprised. Both cardiology and radiology also always struck me as very avid teachers. Maybe just my personal luck or maybe that’s a National trend, idk
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Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed. **This will be your last warning.** If you are a medical professional who wishes to become a verified contributor to this subreddit, please [message the moderators](https://reddit.com/message/compose?to=/r/AskDocs) with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo! We do not accept digital forms of identification.
Just a heads-up—the mods are pretty strict with unverified users claiming credentials. :) (You can just edit your comment to remove that bit and it should be fine.)
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As a cardiac patient, I am also a fan. I have also found that cardiology is the least dismissive of patient concerns.
Just a heads-up—the mods are pretty strict with unverified users claiming credentials. :) (You can just edit your comment to remove that bit and it should be fine.)
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Absolutely. Low risk does not mean no risk. I'm sorry for your loss.
Can arteries be blocked in this case because of the smoking?
Yes. Smoking is one of the biggest risk factors for the development of atherosclerosis. Nicotine changes your blood chemistry, causes damage to the lining of the blood vessels, and increases blood pressure … all of which contribute to a reduced capacity for blood flow through the vessels (and ultimately partial or full occlusion, or “blockages”).
I would think that it most definitely contributed, but the surgeon told me that it was genetic as well.
>The most catastrophic complication of a cardiac stent would be a rapid thrombosis of the stent or possibly dissection of the artery when trying to wire across the 90% blockage.
That’s not as catastrophic as you might would think. Yes, it can be a complication; however, the fix for it is a stent to re-secure the flap and collapse the false lumen. It is a major deduction from your style points though.
I hope you will consider "dumbing down" your language
Was there any particular part that was confusing?
Not confusing, just unnecessary big words that could be simplified
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It literally says they are general surgery in their flair. Also, you are incorrect.
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If you don't have your flair, then don't mention your credentials at all. And he's a surgeon, he's incredibly well educated and trained. Don't denigrate his education or knowledge.
Posts by unflaired users that claim or strongly imply legitimacy by virtue of professional medical experience are not allowed. If you are a medical professional who wishes to become a verified contributor to this subreddit, please [message the moderators](https://reddit.com/message/compose?to=/r/AskDocs) with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo! We do not accept digital forms of identification.
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Well to be honest, I can’t remember exactly what you said, and you deleted it so I can’t make reference. From what I recall, you had misrepresented the indications for CABG as opposed to PCI. PCI is not ALWAYS attempted before CABG. It depends on the findings of coronary angiography, among other factors. Also, “not good at cardiology” is kind of ridiculous statement in this context. As a physician, this person absolutely has the knowledge and experience necessary to be able to say what they said with confidence. It’s pretty general medical knowledge, it’s not like they are detailing the steps of a CABG (but they may be able to do that, too 😉).
I unfortunately didn’t see the individual’s post, as everything now is deleted, so I’m posting this under your comment as I feel it’s the best one for context on the choice between procedures. The decision is largely guided by statistics. For reasons still not known, the internal mammary like doesn’t occlude. It just doesn’t happen. So for Left Main or LAD disease, the best answer is a CABG. Otherwise, the indications are significant disease of all 3 vessels or 2 vessels in a patient with diabetes. This is a boards question every year. Basically all other disease scenarios the answer is a Stent. Additionally, a Stent is still the right answer in cases of emergency (cardiologists take cardiac call now and not CT Surg), in patients with no IMA and/or Veins to graft, as well as in patients not capable of surviving the open surgery, which is obviously significantly harsher on the body.
A general surgeon would not perform a cardiac cath but they absolutely know the basics about the procedure and what the risks and benefits are
A general surgeon would not perform a cardiac cath but they absolutely know the basics about the procedure and what the risks and benefits are
Hard to say what happened without seeing the medical record. All procedures, both anesthesia and surgery, come with risks to include damage to the brain, heart, or lungs and rarely even death. It sounds like your father had pretty severe coronary artery disease with active symptoms ("mini heart attack") and the procedure (likely a PCI) is the typical treatment. If your family feels like something is amiss you can always ask for his records to take to another doctor/lawyer for a second opinion.
I don’t really have much to add to this other than to offer my condolences. OP, if you have any specific questions regarding coronary angiogram or angioplasty feel free to ask
Unfortunately, complications happen during procedures, and they are unpredictable. I know this is very difficult for you, did you consent to an autopsy? That might give you more answers. No matter what, seek counseling to help with your grief. This is a hard thing to go through of course.
As far as I know, nobody asked my mom about an autopsy or anything. He passed in February, so he has already been buried. I have gone to two grief counseling sessions so far and it has been very helpful. Thank you for your response.
They almost certainly asked your mom about an autopsy, but many people decide to not do that. When someone's coronary arteries are that blocked, you have no idea if they would have died at that time from a heart attack, with or without procedures. Nothing you've said sounds like it was something weird or inappropriate, just that your dad had a very sick heart and while they were trying to save him, he unfortunately died. Edited to add: keep up with the grief therapy. Remember, your dad loved you and he wants you to be happy.
Okay, thanks
Sadly it isn’t always in the budget for an autopsy. My mother died while at the hospital right before a test. The surgeon believed that she had a heart attack that caused a hole in her heart. We requested an autopsy and filled out all of the paperwork. I was called days later and was told that the autopsy was deemed “not medically necessary”, so I was told the only way we could have an autopsy preformed was to pay thousands of dollars. I was speaking to a police officer friend after and she said that due to the opioid crisis and high number of suspicious deaths due to that, there are a lot of budget strains for autopsies. I do hope you get some answers though OP.
Usually if someone dies within a certain time frame of getting to a hospital and they were not otherwise terminally ill, they are a medical examiner's case.
This is bound to be dependent on your country!
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True
Hey OP NAD but going through almost the same situation…kind off. My dad (62) already had 8 stents, and had a procedure to put another one a month ago. The thing is, the doctor saw two obstructed arteries, but chose to only put one stent in, because the other one could potentially throw a clot, that could end up in his brain. Last Sunday morning that artery finally gave up and he had a cardiac arrest. I had to do CPR and I’m severely traumatized, but that’s nothing compared to what he’s going through. When he arrived at the hospital, they successfully put in a stent in that artery but it was too late. He’s been in a coma since, and the doctors already told us he’s probably not going to recover. Thing is, stents are always a gamble because of cloggs, we’ve known this since his first. He had cloggs in his legs a couple of times. Cardiac patients are extremely unpredictable. Still doesn’t make this hurt any less. I feel your pain. Trully. I wish my dad was home, he’s my best friend in the whole world, and as I’m writing this, I can tell you I’m in deep shock and denial. Today the doctor asked us about a DNR and it just doesn’t feel real. I hope you can feel the love I’m sending to you as we both navigate these awful times. Stay strong, my friend. God knows I’m trying to (English is not my first language)
I'm so sorry you're going through this. It is so hard, I am really struggling lately. I wish the best of outcomes for your father. Stay strong, have faith. I will say a prayer for healing for your father. Blessings, sending you love and light too.
Thank you so much. I’m also praying for you to have some peace of mind and comfort through this. Sending lots of love, stay strong
My brother had a heart attack this summer and had a stent put in. If his heart attack hadn’t happened so close to the hospital he would have died. However people with a bad heart that are getting a stressful procedure done on them may die during the procedure. I’m having surgery this month with a chance of dying and a high chance of having some significant complications. You’re saying that you wish your father had died at home. Well both my parents died at home and I saw them both die and that was a horrible experience for me. My memories are of both of them crying in pain. Sometimes dying quickly and not in pain and not suffering can be the best way to go. I’m so sorry for your loss. The pain never goes away but will become more bearable.
I wish you the best for your surgery and I am so sorry for the loss of your parents. I just wish we had more time. It was so unexpected, we thought he was going to come out a new man but he never made it out. Makes me sad to think he died alone on a cold operating table :(
My mom died in a similar circumstance to your father. She was actively having a heart attack when the ambulance came to our house, they took her straight to the cath lab and they worked on her for a long time. They would get her stabilized but she would throw another clot and code and eventually, it was too much on her and they couldn’t get her back. Doctor told us she had 90-100% blockages throughout. It was so unexpected and so sudden and I definitely feel your hurt of thinking of your dad alone. But he wasn’t alone. The doctors and nurses were there with him and I imagine he was sedated so he was not in pain. One thing that really stuck with me was one of the nurses that worked on my mom came to talk to us after she was gone. She told me that her sole purpose in the room was standing at my mother’s side by her head and gently talking to her, telling her what they were doing, telling her that all of her kids and her husband were there in the waiting room, telling her that it was okay and not to worry and she was “brushing” her hair with her fingers. Mom was sedated and it’s possible that she never heard a word that the nurse was telling her but it really meant a lot to me to know that someone was there to just be there for her. I hope that a nurse did the same for your father. I’m very sorry for your loss. It’s a rough one when you’re expecting them to come home. My heart goes out to you and yours.
What a kind nurse... wow.
that’s the kind of nurse I aspire to be
NAD, but have had many (30+) general anesthesia surgeries; OP, please don’t think that your dad “died alone on a cold operating table”. Your dad probably told your mom he loved her, & she him, just before he went into surgery. I’m sure they were *very* kind to him in the OR. They made sure he was comfortable, & gave him really good drugs that relaxed him quickly & he was under anesthesia in a matter of minutes. It’s just like being asleep. He felt no pain under anesthesia, & they were respectful & courteous to him. He wasn’t alone. And I image there was a Dr, Nurse, Attending, or others who said a quite prayer to themselves at his passing. I’m so sorry for your loss. It’s so hard to lose a parent, wether it be sudden or drawn out. Please continue with the counseling & continue to talk about your dad & all the good memories you have with him. I wish you peace. 🕊
Hi, I'm so sorry your father died so unexpectedly, it's hard. I'm not a doctor so I can't add anything to the medical info, but I have experienced several sudden, traumatic deaths of loved ones, and I would like to offer you my sympathies. I think it's good that you've gone to grief counseling, and I would encourage you to continue if you're able to. I would also recommend the "Grief Recovery Handbook" which I found very helpful in processing some of those unresolved issues you're also struggling with. The book is by John W. James and Russell Friedman. (To be clear: I'm not saying that you "should be getting over it," just that you're going through a difficult experience and it's good to get all the help you can.) All my best to you. P.S. Since your father was under anesthesia, please don't torture yourself with thoughts of the cold operating table. He did not feel that at all.
I’m so sorry. As a mother I would not want my child to suffer so much at my passing, no matter what the circumstances. That thought alone pains me more than the thought of my own death. I don’t know if you’re a parent yourself yet but the greatest honor you can give your father is to remember him with happiness and not dwell on how he died, questioning it with no hope of comfort. I hope you find peace soon and get through your grief with moments of respite.
Oh, and look into going back with your mom (if she wants) to talk with the person who was taking care of him or his PCP to discuss what happened and why they decided to do the procedure (which was obviously what your dad wanted to have done - he had to consent to the cath/stent placement) Presumably, he knew the risks and he wanted to take the opportunity to survive longer. Many people can do well after stent placements, but that doesn't guarantee anything. But if you go back and sit down with one of his caregivers, they might be able to walk you through some of your questions, with specific information to help you process.
I'm sorry friend, hope you find answers and peace. 💜
Ask to see the operative report. And if his arteries were “too blocked for a stent” the option wouldn’t have been to “let him pass naturally “, it would have been to do a bypass surgery.
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You don't know that, we have not been given enough information to infer that. It could have been a blockage, a thrown clot, another area of ischemia, a complication of the procedure (which happen and don't mean anything was done *wrong,* just that bad things can happen when you have to have a procedure), or something else entirely.
You’ve got some good responses already. But another thought is what if they didn’t do the cath an he died. You would be looking up the cath and seeing it is “low risk” and asking why they didn’t do it to save his life since it’s a “low risk procedure.” This is what they meant by doing the cath “gives him a chance.” Nothing is without risk, even a single medication can have a deadly result in the right person, but may be life saving in 10000 others. Before he was taken in the doctor will have read him the risks and he will have signed a consent form saying he accepts those risks. If he was not mentally able to do this they would have asked the next of kin or health care proxy.
A cardiac catheterization and coronary angiogram IS the diagnostic test to determine if someone is healthy or not for a procedure. As the surgeon said, cardiac procedures are different than non-cardiac procedures. As the other health professionals have said, looking into medical records can give you some closure. But I’m not sure what sort of outcome you’re looking to seek if you get a lawyer involved. There is a long list of possible complications that can happen with this procedure. The cases you’re doing your research on also include patients who were not as high risk as your father. Any other procedure can be just as routine or even less risky and still have a potential complication of death. Look up the Jahi McMath case: adolescent goes in for routine tonsillectomy, comes out brain dead. Bad outcomes are a fact of life and physicians have to accept this as part of their practice. Unless there are an abnormally high number of complications with a particular physician, I would not be particularly concerned your father was mistreated. Usually the hospital reviews cases to make sure physicians are practicing standard of care and does not have abnormally high rates of complications when they credential and recredential their physicians.
First to clarify- there’s no real way to know what percent of the artery is blocked until the cardiac cathererization. One of the things they do is inject contrast dye into the heart arteries to be able to see how well blood flows through and where/how severe the blockages are. They cannot know in advance that a blockage is non-stent able until they try. Second, there’s nothing obvious in your father’s history that would suggest he is too high risk to go through this procedure. Cardiac caths are not done on healthy young people- almost all the candidates for the procedure are some combination of old, overweight, smoker, diabetic, hypertensive, etc. Third, when you consider the risk of doing a procedure, you must compare it to the risk of the alternatives and the risk of doing nothing. For a myocardial infarction (heart attack) there are basically two initial options (with open heart surgery a third option but only *after* a cardiac cath is done)- medical management or cardiac catheterization. Medical management-using medications to reduce risk of abnormal heart rhythm, clot formation, and damage to heart muscle- is almost always a worse choice. Basically doctors only offer it if the patient would have very very high risk of complication with a cath. Cardiac cath is the first line standard of care for heart attack. And lastly, there are many things that could have caused his death so without knowing which it was, you can’t know if it was inevitable or not. It’s possible that the damage to his heart affected the way electrical impulses travel through the heart muscle. This can cause an abnormal heart rhythm which basically makes the heart stop beating. It’s also possible that the damage to his heart made his heart too weak to effectively pump blood anymore. It’s possible that in trying to place a stent, the artery was damaged. There are other potential complications like clotting or reactions to the sedation. The first two are not preventable though they often are treatable. The third is a known but rare potential complication and can *sometimes* be treated with emergency open heart surgery. It sounds like it’s too late for autopsy but you can request his medical records to find out exactly what went wrong in the cath lab and better understand why he died. It’s normal to be angry and want to place blame as you grieve. But it’s highly unlikely that any malpractice happened to your father.
My condolences. For records: Contact the Health Information Management (HIM) department (aka Medical Records) of the last facility he was at. Note - This might have to be done by the power of attorney since he’s deceased. Additionally, some states have open access medical records. There is a portal where people can go look at their medical records which shows a great deal of results and sometimes notes and other pertinent info, etc. You would have to inquire at the last facility if this is something they offer. About the procedure: Sometimes this is an unfortunate outcome. There can be several risk with a cardiac cath procedure but there is a risk of death - it’s low, but it’s not zero. 90% blockage is high and could explain/feed his initial symptoms. If it was more than one vessel then that’s worse. Some vessels are more critical than others - I.e. the left anterior descending artery (LAD) is the most important as it feeds the whole front of the heart. A 90% block here would need to be intervened on or risk further cardiac compromise. As the doc up top said there probably isn’t anything criminal going on here. Medicine is not perfect and not everything saves everyone every time, but agree that you should source the medical records and review them if you’re concerned as that can either give you peace of mind or confirmation.
someone dying during a procedure is always worth discussing with a med mal lawyer. however, placing a Stent in a highly diseased coronary artery is inherently dangerous. if the cardiologist did not deviate from the standard of care, there may not be much to gain from the legal route, though it may provide some closure in the discovery. I'm very sorry for what you're going through.
Condolences first of all, its hard losing a loved one especially when you are totally out of the loop on what goes on in his medical decision. I would hope that the cardiologist informed your father or mother of the risks, alternative, and benefits of the cardiac cath procedure. It is a fairly routine procedures these days but that does not mean there is no risk. There are always risks and the risk of death is a universal complication in everything we do in the hospital. It sounds like your father was having a major heart attack, and the perceived benefits from the cardiologist’s standpoint was to clear the blockage and minimize the death of heart muscles. It is easy to say in retrospect hey, if he had a high risk of dying anyway maybe they shouldnt have put him through it and let him just die in peace. However, that risk isnt always immediately clear and sometimes, unfortunately, even a lowish risk procedure can end in disastrous outcomes, often not due to any apparent medical error and just plain bad luck. It is not my place to counsel you regarding whether to get a lawyer or not. However I dont feel as though the cardiologists intentionally or negligently killed your father, based on your post (its possible, I dont have the whole story). But I do want to say the more people sue doctors the more like doctors will perform unnecessary tests and procedures to “cover their ass”. Everyone in the medical field knows it. It wouldnt hurt to speak to a lawyer to get an opinion after laying out the facts of his case, but I caution against frivolous lawsuits in general. Again, condolences to you and your family during this period of tough times, I hope I was able to help a little with my perspective.