Thursday, March 24, 2005

Chest pain = angiography = bypass surgery

We are seeing an epidemic of bypass surgery ( coronary artery bypass surgery, CABG, or cabbages as they are fondly called by cardiac surgeons in the US!) It seems to have become a routine that every patient with chest pain is sent to a cardiologist, who does an ECG and finds "suspicious changes"; advises a stress test, which confirms the suspicions, which then inexorably leads to an angiography, which invariably detects a block, which is then treated by angioplasty or surgery. While this cascading effect is extremely good for a hospital's bottom line, how much this actually helps the patient with chest pain is anyone's guess ! The technology for treating blocks has become fancier and glitzier, with balloons, stents, coated stents and drug-eluting stents; and it's so seductive to fix a block when you see it, that no one bothers to question the logic or utility of doing so. Many of these blocks are benign, of no clinical importance, and could be left well alone, but with the fear psychosis created in patients' minds of "impendig death" around the corner if the block gets clogged up, few patients have the courage to say no to surgery. Relatives are also often bamboozled into signing on the dotted line, because they are made to feel guilty if they don't cough up the money for the surgery. However, few patients know that CABGs don't extend life expectancy, except in a small group of selected patients; or that there are major deleterious long-term effects of bypass surgery on the brain, which no surgeon tells you about ! You need to ask lots of questions before saying yes to a CABG !

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