Post Heart Attack-Bypass or angioplasty

[DE]

I have a female family member who is 55 years old and has diabetes.  After experiencing severe indigestion, she was given an EKG and told she had a recent heart attack with muscle damage.  She was not put in the hospital, but was sent home on beta-blocker which made her overwhelmingly tired.  Five days leter, she came in for a nuclear strss test which showed an EF of 30-35%.  She was taken off the beta-blocker and put on ace inhibitor. She then told me she had damage to up to 50% of heart. She returned home and 3 days later had a catheritization which showed 2 blockages and addiional damage in the middle as well as the front of heart.  Her EF was 25-30%.  She was taken off all medication and sent home.  She will see cardiologist this Monday(4 days afte cath).  She is reluctant to have bypass surgery and is leaning towards angioplasty.  Is the long-term success of these two procedures different for a diabetic?  She had a respiratory illness in April that was hard to clear up and does have a dry cough that has seemed worse these last few months.  Should she be on medication now?  Can she increase her EF with surgery or angioplasty?  We all want to help her.  Thank you.

[CCF CARDIO MD JMF]

Dear De,

Given that she is a diabetic with a reduced ejection fraction, CABG would be the alternative that , if appropriate,  would prolong survival.  An angioplasty might be appropriate for intervention on a single lesion if that is the case.

she should be on an ACE inhibitor, low dose beta blocker if tolerated, asa, cholesterol lowering agent and tight glucose control.

[sukumar794]

A related discussion, Lone Medications was started.