family member's echo results, on hospice - possibility could survive?
I have the echo results for an 85 yo female (a family member, we are POA) who had massive MI 4-5 days prior hospital/ER visit. Couldn't cath because of kidney function; alert and oriented, made the decision that she did not wish any aggressive 'life-saving' treatment. These are the echo results from hospital stay:
Left ventricle: severe hypokinesis of basal-mid anteroseptal and apical septal wall(s). severe hypodinesis of basal-mid interoseptal and apical septal wall(s). severe hypokinesis of apical wall(s). severe hypokinesis of mid-apical inferior wall(s). features were consistent with a pseudonormal left ventricular filling pattern, with concomitant abnormal relaxation and increased filling pressure (grade 2 diastolic dysfunction)
Aortic valve: valve was trileaflet. leaflets exhibited moderately reduced cuspal separation and reduced mobility. transaortic velocity was increased due to increased transvalvular flow
Mitral valve: there was mild regurgitation
Right ventricle: size was at the upper limits of normal
Tricuspid valve: mild regurgitation
Right atrium: mildly to moderately dilated
Inferior vena cava, hepatic veins: respirophasic change in diameter was less than 50%
Pericardium: large right pleural effusion. moderate-sized left pleural effusion
Has been in hospice care for 2 weeks now. Hospice caregivers have been making comments that hospital MDs "jumped the gun" by placing patient in hospice care and "shouldn't even be there" that other family has overheard.
Question: could she survive and live a good quality of life? What would be possible treatment options - if she was taken off hospice and treated (ie: cath, CABG, etc), would she be able to survive procedures? Are the caregivers in fact correct about MDs 'jumping the gun' and placing her in hospice, or is she doing extremely well despite diagnosis/results? Is this type of heart damage 'reversable' after an MI?
I don't think anyone can really comment because there are so many unknowns here. You have only had one test performed, an Echo, and this gives very limited information in relation to vessels. It deals more with muscle motion, dimensions and valve functionality. My personal opinion is that they need to get the Kidneys working to a cath can be done. However, I think I would rather have a nuclear perfusion scan first. This will show how much heart muscle is damaged beyond repair, and how much can be saved. If nothing can be saved, then there is no point doing a cath.
What is the EF of the heart at the moment? It may improve because your family member may open a few collateral vessels which are natural bypasses. I would have thought some have opened to survive such an acute attack.
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