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[katiejs4]

My uncle had a heartattack a week ago, and went in 6 days later with a code blue called. He is surviving off of one artery which is significantly blocked and has 3 stents in it. He had a heart attack 20 years ago and had 5 bypasses. The dr says that he can't/wont opperate on his heart because it is too weak. He's been in ICU for 4 days now, off of O2 now and they are keeping him stable with meds. What are his options? pacemaker? I know hes not a canidate for a heart transplant. I  feel that the medical team his done a poor job explaining everything to the family and I don't know what kind of questions to ask. Any help or tips would be appreciated.

[Dr J Singh]

Hi,
A pacemaker is required only if there’s a suggestion of a very slow heart rate or a heart block which is not able to maintain a normal ejection of blood from the heart to the vital organs. In your uncle’s case, it’s probably a poorly functioning of the heart due to considerable damage to the heart muscle which has resulted in a poorly functioning heart and thus he’s in ICU.
You can ask the following questions from the treating physician :
1. What’s his ejection fraction? If it’s normal or not?
2. What’s the overall prognosis?
3. Is there any heart/conduction block requiring a pacemaker?
4. Can heart transplant be considered?
5. Does he require any surgical procedure or are medications sufficient?
6. Will he require certain specific medications to tide over the crisis and which need to be continued over a period of time after discharge from the hospital?
I sincerely hope that helps. Please do keep me posted. Kind regards.

[npc3]

I'm sorry for your uncle.

If the docs wont operate then they wont put in a pacemaker.  A pacemaker does not seem to be needed.  Your uncle's problem comes from clogged arteries due to high cholesterol (either from diet or genetics or both).  The arteries supply blood and nutrients to the heart muscle itself to keep it alive. When the heart can't get it's blood supply you have a heart attack.  Looks like they put stents in the artery years ago which keeps the artery open.  However, your uncle must have kept producing plaque (cholesterol buildup) either by not taking his meds and/or poor diet. Now the arteries are clogged once again.

I'm not sure what the next step is.  Seems like some sort of surgery is going to be required, either more bypasses or stents.  Perhaps they are keeping him stable in ICU giving the heart muscle time to heal and get stronger for surgery.

You need to simply ask the doctor what his options are.  Ask for things to be explained when you don't understand something.  Doctors don't bite.

Let us know what happens...best wishes to you and your family.