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Triple vessel Disease
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Triple vessel Disease

My father, a know case of IHD, post CABG( 1995) with SVG grafts to LAD, OM1 & OM2 on regular treatment was recently admitted to hospital as per doctor's advice ( unstable angina) for further evaluation and management. he is nondiabetic and hypertensive, non smoker all his life, maintaining a strict n healthy routine as suggestive of heart  conditions.
2D echo revealed good LV function with an EF of 60%.
Coronary Angiogram on 15/04/13 revealed Native vessel - Triple Vessel Disease. SVG Grafts to OM1, OM2 were blocked( known earlier). SVG to LAD was patent, but had a tight lesion in mid segment.

he is at times complaining of breathing difficulty only at night time, not severe.

Going for a second bypass ruled out due to the complications, age, recovery factor.
Stent successful chances are very less as per doc.

Please advice what care to be taken what symptoms to be looking for incase the case is getting serious...

Thanks in advance for your valued suggestions....
976897_tn?1379171202
The only factor you have which gives clues about a this condition worsening is an increase in symptoms, such as discomfort or dizziness. I'm surprised that his EF is so high to be honest, 60% isn't bad at all. One thing which concerns me is the hypertension, which should be controlled by medication if necessary to keep it normal, allowing the heart to relax more. Perhaps beta blockers would be ideal, which not only reduce blood pressure, but block the beta receptors on the heart preventing it from jumping hard into action.
I do have a question. The LAD is being fed by a graft which is still open, but has a tight restriction in the middle. What was the condition of the LAD before the bypass surgery? was it blocked totally? and what area was the blockage?
You say the OM1 and OM2 are blocked and these are vessels off the Left Circumflex. This is why I am surprised that the EF is 60% and with the LAD in short supply on top of this. I have the feeling that there must be some collaterals at work. Do you know if he is right/left or co-dominant?
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