Husband has vascular dementia. He is in a MC facility. He recently had ischemic heart attack. Echo showed some blockage but minimal damage to heart. Doctor wanted to do cauterization under mild sedation. Spouse will easily become agitated and aggressive so I said no. he’s being treated with meds. What happens if he has another attack? What Would you do about the cauterization? He is not a cooperative patient? He doesn’t understand what is happening to him. He’s not able to adequately communicate? I have conservatorship.

I think the goal of treatment needs to change when someone is suffering from dementia. The goal for a basically healthy person is usually to extend life. To me, when someone has a condition like dementia or end stage congestive heart failure where there is no chance of recovery, the goal needs to be preserving the quality of daily life. Several family members objected when my mother (his primary caregiver) started restricting some of my grandfather's food choices as his doctor reduced the amount of sodium he was allowed (and increasing his diuretics). Several family members felt he should be allowed to eat anything he wanted in any quantity. The problem was when he ccnsumed too much salt, the swelling in his hands, feet, and legs made him very uncomfortable and made walking difficult. The doctor warned some patients would have the skin on their legs spilt open and with the reduced circulation from the heart, the splits would not heal and could easily become infected. When Grandpa stayed within the sodium levels the doctor recommended, he felt better, enjoyed sitting up in his bed or easy chair and visiting with family and friends all day long.

My father also had vascular dementia and heart problems in his later years. Some procedures, like stent placement and a pacemaker, improved his daily life and made him more comfortable. His doctor was able to use anti-anxiety and sedation to make the experience of the procedures easier. More intrusive procedures, like coronary bypass, were withheld. One of the more difficult decisions for me was about a hip replacement: I was concerned Daddy would not be able to rehab properly after surgery. Because of the pain and limited mobility his hip was causing him, I very reluctantly allowed the surgery and to my surprise he rehabbed very well and enjoyed his new hip for a number of years.

In most cases, there is no "right" decision. There's only you making the best choice you can considering all the factors.
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Reply to TNtechie

I just had a cardiac ablation (basically what you are talking about) and it was a game changer. I didn't realize how much the SVT was bothering me.

BUT--I am a 66 yo woman in basically good health. The procedure was long-ish but the sedation was about as minimal as it could get. I shook it off in a day, which is not normal for me.

If I were in a care facility, I would want palliative care only. Doesn't matter how old I am, I just wouldn't do it.

However, this is a decision you need to make for DH. There's no right or wrong--just a choice. But do your research and talk to the Dr about all possibilities of outcomes.
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Reply to Midkid58

Take him or call his neurologist for second opinion about any surgeries. Is it possible that the blockage of blood flow to heart can also be blocking blood flow to the brain 🧠? What if this procedure helps with both? It’s just a thought. He’s kind of young to just give up on, my opinion. Hugs 🤗
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Reply to CaregiverL

No, he should not. That would just extend his suffering.
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Reply to polarbear

So sorry to hear about your difficult situation. If my spouse were in MC, I would not do anything to increase the time he has to suffer with dementia. It is a horrible life, IMHO, and I would be looking at ways to keep him comfortable as opposed to extending his life. When/if it is appropriate, I would instead be looking at when hospice is needed to keep him pain free.
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Reply to againx100

I would not have the catheterization myself. However, this is a decision you need to make while FULLY INFORMED, and I do mean informed by the MD, not by folks on a Forum.

First thing you need to know is that, knowing your husband's deficits, they will almost certainly be able to medicate him to a level of comfort. Second thing I would tell you is that they can sometimes put in stents (think little tubes to hold sclerosed and narrowed arteries open more, thus increasing blood flow. This is non invasive and may benefit him.

THIRD things you need to know is that you have a right to have all of this and MORE explained by the cardiologist so you can make the best decision for your husband.

The reason I would not have this done is that were this my husband, and knowing now how he feels, he would not wish to survive long with mental impairment. Therefore, a heart attack giving him a final exit would not be my concern, and would be in some ways a deliverance he would wish. I felt the same about my brother who very much wished to die rather than face down decades of loss from his diagnosis of probable early Lewy's dementia. I was glad when sepsis too him in a relatively short amount of time. He had a good life. He would have hated mental losses and was already suffering them. I hate the idea FOR him.

So this is a personal decision. No one knows your husband better than you. The decision is now in your hands as to whether to do palliative or hospice care.

As to what happens with a heart attack? Each is as individual as your own thumb print. Some are deadly and some are not as you can see by your husband's current condition.

I am so sorry. This is such a dreadful things to be called upon to make a decision that MAY/May NOT be life threatening, or make a decision to move forward (because things can go wrong in these procedures as well. Nothing in medicine is benign).

I hope you have support. If the MDs will not take the FULL time to explain everything to you and help you with this decision then my answer would certainly be a hard NO. Good luck, Carchie
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Reply to AlvaDeer

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