Geriatric Cardiology and "Pump Head" Revisited: Podcast with Liz Whitlock and Mike Rich

A September 2000 New York Times article titled, "Sometimes Saving the Heart Can Mean Losing the Memory" describes a relatively newly described phenomena of difficulty with memory and other cognitive tasks six months after cardiac bypass graft surgery, or CABG. The syndrome was termed "pump head." A doctor is quoted in the article as stating that older patients he might have previously considered CABG for he would try to manage medically, with a stent. Data on the impact of CABG on cognitive function over the subsequent 20 years has been mixed. The problem with these prior studies is they enrolled patients at the time of the CABG. They didn't have a sense of what the cognitive trajectory was before the procedure.

In this context, enter Liz Whitlock's study published this week in JAMA comparing cognitive trajectories before and after CABG versus stenting procedures. Liz finds no difference in the decline in memory before or after CABG vs PCI - in other words - their memory continued to decline at the same rate after each procedure as before. Furthermore, a newer procedure intended to spare patients the risks of bypass, called "off pump" CABG, was found in this study to be associated with greater memory decline than on pump CABG.

Pump head, it seems, is not a thing. Those who get CABGs likely also had vascular disease in the brian that was leading to a steady cognitive decline before the procedure.

To contextualize these findings for practicing geriatricians and other PCPs, we are joined by Mike Rich, one of the early movers and shakers in the field of geriatric cardiology. We are doing these cardiac procedures on ever older and older patients. What should we be concerned about? How should we counsel our patients? Listen to find out!

-@AlexSmithMD