Angina, Global Kinesis

[PKP1977]

My Father is 65 yrs, known IHD for past 25 yrs, started complaining of Chest pain a month back & we got ECG, Thallium Scan, Angiogram done.
Angio results are below:
- LMCA Normal
- LAD : TYpe III vessel showed spontaneous dissection in its proximal portion with 80% segmental block. Distal LAD is graftable. I Diagonal showed 90% segmental block inn its proximal portion. Distally its a medioum sized vessel.
LCX : Non-Dominant vessel showed 80% narrowing in its proximal portion. Distal OM2 is graftable. OM1 is a big vessel & showed 80% block at its ostea. Distally its graftable.
RCA : Dominant vessel, PD showed 80% block in its mid portion.
LV : LV angio RAO view showed dilated LV with reduced contraction. EF is ~25-30%. Apical kinesia present


ECG results:
- Dilated Left Atrium / LV
- Moderate LV Systolic dysfunction, EF - 38%
- Global Hypokinesia of LV
- Mild MItral Regurgitation
- No Clot/PE/Vegetations

Myocordial perfusion Study results:
- LAD Territory : Transmural Infarcts is seen in the apical & distal anteroseptal walls. Rest of the territory is well perfused. No evidence of inducible ischemia in this territory.
RCA & LCX Territory : Mild reversible ischemia is seen in the basal inferior & inferolateral wall. No infarct in this territories.
General SPECT : LVEF 25%. Global Hypokinesia
Rest of the myocardium is well perfused.

currently doctos finalise:
- Effort Angina
- CAD with involvement of LAD, LCX & RCA with reduced LV function
- Peripheral Heart disease
- CABG at the earliest.

Question:
Are there known cases in history with above scenarios..? What was the treatment & medication followed..? What were the results..? What will be the best course of actions in these scenarios..? Please advise ... any idea of who are the Doctors in India who might have handled such cases..? Thank you...

[PKP1977]

Thank you ... our surgeon & Dr are recommending both ... will have to select what is best for him at the long term...

[akh71]

i went through the report.
u r father has coronary artery disease with sever lv dysfunction and thallium scan show major nonfunctional myocardium.

he is in critical condition. first option would be cabg(bypass operation) which is best but very high risk. his EF 25% i s lowest possible limit to survive he must be quite symptomatic as well.
second option angioplasty followed by stenting atleast two vessel will improve his condtion and risk would be less than surgery.
at the end i would like to tell u cabg is best and it has long term good result.