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echocardiograpy and non invasive angiography

Dear Dr,

My dad is based in New Delhi, India and had a stent put in 10 years ago, followed by a single vessel bypass in the same artery 9 years ago. He is currently seeing a doctor for checkup who suggested he undergo echocardiography. We received the results from the lab and the doctor mentioned that the heart pumping has reduced (my dad's age is 72).

The doctor suggested he undergo a non invasive angiography (using dye), which will provide more information to rule out problems and identify if we really need to perform any angioplasty.

I will highly appreciate your kind review of my dad's echo cardiography results and a second opinion about the true picture of his health and a recommendation whether we should go for the non invasive angiography.

Here are the results (200 words):

Echocardiographiy report

Echocardiographic window : poor
2D and M mode cardiography
Left Ventricle
EDD : 48
IVS : 09
Ejection Fraction: 42
IVS: Intact
2D: Normal LV size
AO: 32mm
ESd: 37
PW: 12
FS: 24
LV Clot Absent
IVS Moton: Normal
LA: 32 mm
LAD Region: Anterior septum and apical septal wall hypokinesia.
RCA Region: Normal basal septum, basal inferior and mid-inferior segments.
LCX region: Normal basal posterior and mid-posterior segments basal lateral and mid-lateral segments.

Left Ventricle : Normal
Contraction: Reduced
Regional Wall motion abnormality Present
Left Atrium: Normal
Right Atrium: Normal
Right Ventricle: Normal

AML - normal
PML - normal
Subvalvular deformity - Absent
Doppler Anbormal
Mitral Stenosis : Absent
Mitral Regurgitation: Absent
Jet Area ....cm square

Morphology: Normal
Doppler: Normal
Tricuspid Stenosis: Absent
Tricuspid Regurgitation: absent

Morphology - Normal
Doppler - Normal
Pulmonary Stenosis: Absent
Pulmonary Regurgitation: Absent

Morphology : Thickened
Number of cusps: 3
Doppler: Normal
Aortic Stenosis: Absent
Aortic Regirgitation: Trivial

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469720 tn?1388149949
Looking at the echo, the results are really not that bad except for the fact that his ejection fraction is depressed as your doctor noted. However Im not sure how much it has changed over the last decade. It does not sound as if he has had any major cardiac event over that time.

The major question is what type of symptoms if any is he currently having. Chest pain, decreased tolerance to exertion, shortness of breath or fluid accumulation. If he is having any of these symptoms, the study is definately indicated. If he is not having symptoms, then it becomes a judgement of the benefits of medication/no procedure versus looking additionally with the described test or another similar.

The need for the test is also dependent on how healthy your father is. If he is 72 and very healthy, then I would be inclined to suggest that you proceed with the testing to optimize his condition. Finally if he has no kidney problems, then the risk of administering contrast should be minimal

In summary, if he is having symptoms and is in otherwise good condition and you are going to a physician that you are comfortable with, I would suggest that you might consider proceding .

Good luck and best of health
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