This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Valery A. Portnoi, MD
Genesis Physician Services Inc Washington, DC

JAMA. 1997;278(12):977.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—As a practicing geriatrician, I enjoyed reading Dr Lynn's discussion of Mrs J, an 88-year-old woman at the end of life.¹ I have under my care a 92-year-old woman with strikingly similar conditions, ie, severe aortic stenosis, coronary artery disease, and congestive heart failure (CHF). But, in contrast to Mrs J, 2 years ago my patient reversed her initial decision to have hospice care and underwent 2 balloon valvuloplasties.

It appears that Mrs J 1 year before discussion was ready for more aggressive treatment. Otherwise why would she consent to cardiac catheterization? Open heart surgery was not a good treatment option, as Lynn commented. But what about valvuloplasty? A wide range of invasive treatment options can be successful, even in very elderly patients.²

Regardless of decisions regarding invasive procedures or surgery, medical management of CHF should be optimized for the patient discussed by Lynn. Angiotensin-converting enzyme inhibitors are a . . . [Full Text PDF of this Article]

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?