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Post Heart Attack
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Post Heart Attack

My sister is in her mid-50's, is diabetic and after a week of on and off indigestion, the discomfort increased one night.  the next day she felt better, but discomfort returned.  She went to the closest small hospital and had a "questionable" EKG.  After bloodwork came back clear, she went home.  Two days later, a cardiologist told her she had a recent heart attack, with substantial damage and put her on a beta blocker and sent her home.  Five days later, she had an a nuclear stress test and stopped the beta-blocker(it wiped her out) and was put on ACE inhibitors.  The stress test showed the heart attack was in the front of the heart( descending aorta) with an ejection fraction of 30-35%. Three days later, she had an ultrasound and returned home.  Four days afte that, she had an angiogram, which showed two blockages and additional damage in the middle of the heart as well as the front.  Her ejection fraction showed to be 25-30%.
She was taken off the AC inhibitor and is now at home, not on medication, and awaiting an appointment seven days after angiogram, to discuss bypass versus angioplasty.  My questions are:

1.  Should she be on medication now?
2.  Is bypass a better solution for her situation?
3.  What are the risks for each?
4.  What information tells me that her doctor's institution is experienced?

We all want to help her.
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1. Should she be on medication now?  Yes, she should be on aspirin, ace inhibitor and a beta blocker if tolerated.  she may also need nitrates and a diurtetic.  cholesterol should be lowered and diabetes tightly controlled.  
2. Is bypass a better solution for her situation? The solution to her problem depends on how much more heart muscle is at risk.  Given that she has already had extensive damage to her heart muscle with an EF of 25 % it may be prudent to have a PET scan performed to determine if there are areas of ischemia or hibernating myocardium that will benefit from surgery.  In general, CABG is a better alternative to multiple vessel angioplasty in a diabetic with a reduced ejection fraction.  
3. What are the risks for each?  Tis will need to be discussed with the individuals performing each of these procedures as rates vary.  At Cleveland Clinic, operative mortality for all comers is less than 1%
4. What information tells me that her doctor's institution is experienced?  this is usually determined by the volume for example CCF performs more than 4000 surgeries per year.  Many institutions may only perform several hundred.  Years of experience.  You also need to assess ancillary services ( if a problem arises).  

3 Comments
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Avatar_n_tn
In my humble opinion your sister should go back on the beta blocker immediately!

Doctors prescribe beta blockers because they lessen the work load of the heart, which is very important after a recent heart attack.  Your sister is still in danger of another heart attack or further damage before having any procedures which she may have done, and the beta blocker is a cardioprotective medication.

My experience is that it takes 3 or 4 days or more to adjust to the medication.  Since my M.I. in July I have reduced from 50 mg of Atenolol to 25 mg and now am down to 12.5, which is almost nothing.  Each time that I have changed the dosage, I have had 3 or 4 days of wooziness.

My experience is that this medication shouldn't be taken on an empty stomach and should be taken at the same time every day.  I cut the pill in half and took it twice a day, instead of once, to give a more sustained dosage.  Otherwise 50 MG will have a strong effect within a few hours after taking it, but will taper off later in the day.

I don't believe that I will need to be on a beta blocker indefinitely, however.  I have been able to lower my heart rate and blood pressure with daily exercise, dietary changes, and stress reduction and have been able to lower my dosage over the last three months.  I do certainly believe that it was an extremely helpful medication after the heart attack.
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Avatar_n_tn
Thank you for your comments.  Beta blockers are an essential medication in cardiology.
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