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Building a career in cardiology and palliative care
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A 68-year-old man with ischaemic cardiomyopathy presents with acute on chronic systolic heart failure with severe mitral regurgitation. He has a history of coronary artery disease status post-coronary artery bypass surgery, stage 3 chronic kidney disease and diabetes. He is deemed high risk for surgical valve replacement and is being evaluated for transcatheter mitral valve intervention. In a goals-of-care discussion, he expresses that it is important to him to be functional and independent in his daily activities, and he wishes never to be placed on dialysis. His independence is more important to him than longevity at all costs. He is unsure how he feels about mitral valve intervention. His son, who is his healthcare power of attorney, is in favour of the intervention because he wants his father to live as long as possible, even if he is not as independent as he would like to be. They ask you how they should proceed.
http://dx.doi.org/10.1136/heartjnl-2021-319967
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