Geriatric pt suddenly loses all strength on one side and falls. In the fall, the patient suffers ipsilateral fractures of the femur and radius. Ortho puts pt on schedule for IM rod of the femur.

Initial anesthesia exam reveals pt who appears to be oriented, but is very HOH and therefore it is very difficult to obtain history or provide informed consent. Pt denies significant health history. EKG shows A-fib, chart indicates patient is on BP med. Chest x-ray shows diffuse interstitial lung disease. Labs show elevated BNP level. BUN and creatinine are elevated sufficiently to suggest renal insufficiency.

Physical exam is unremarkable except for systolic murmur that can be heard with the bell of the stethoscope off the patientís chest. Surgery is deferred for further cardiopulmonary workup.

Echo shows EF of >50%. However, there is atrial and ventricular dilation, with moderate to severe regurgitation at the pulmonic, tricuspid, and mitral valves, and an eccentric jet at the mitral valve. Pulmonary hypertension is also present, with estimated pulmonary systolic pressure > 110. Thalium study shows severe interstitial lung disease.

Discussion with cardiology reveals patient has no prior record with them. The patient is in A-fib of unknown duration, for which the patient has never been treated. Cause of the fall is believed to be a cerebral event, as immediately afterward, the patient was completely unable to move the right side of the body. This problem appears to have resolved. Hemodynamically, the patientís condition is precarious at best.

Ortho wants to put patient back on schedule for IM rod of femur. Your hospital can do diagnostic heart caths, but has no cardiac interventional capability.

Do you take this patient to your OR?