Dr. George Tolis, Jr.

I was alerted on a Sunday morning by a cardiology colleague that he was transferring directly to the cath lab via Med Flight a patient with a presumed acute myocardial infarction from a hospital about 40 miles away from Boston. The patient was intubated due to florid congestive heart failure, had diffuse EKG changes and would most likely require emergent revascularization if opening up the "culprit vessel" would not suffice.

It turned out that this man had a coronary angiogram at age 78 which would make any 20 year old jealous. He had a dominant right coronary artery which looked more like an external iliac vessel and a left system which could take over the mesenteric circulation any day of the week and then some. The interventionalist, however, had a very hard time crossing the aortic valve, and after some skillful manipulations was able to obtain left ventricular hemodynamic measurements. The peak systolic gradient was in excess of 90mmHg.

I personally reviewed the history and physical from the outside hospital's emergency department. The template was a beautifully laid out document, with multiple entry boxes which needed to be checked out by the emergency department staff. There was a check right next to the "normal S1 and S2" box, another check next to the "no murmurs, gallops or rubs" box, with the "comments" lines left blank.

Aortic stenosis was diagnosed via femoral access in the cath lab, utlizing the latest interventional cardiology techniques, including a Perclose device for control of the femoral puncture site.

With such advanced technology available in the year 2007, who needs a stethoscope?

Merry Christmas and Happy New Year!