cardiac problem

[malsaadi]

Description: the Patient IS 61 YEARS old , heavy smoker , who underwent a coronary artery bypass surgery in 2001 wherein he received one vein graft to diagonal, PDA and marginal and one LIMA to LAD
Current: the Patient has continued smoking for the last 11 years and presented with abdominal pain raised enzymes and ST depression which resolved with nitroglycerin echocardiogram showed wall motion abnormalities in the lateral and posterior territory and was referred for cardiac catheterization
Reports:
1- Cathlab report: COR ANGIO–coronary angiogram(find the attached full and detailed report)
showed that Left main coronary artery, Left anterior descending artery, Left circumflex coronary immediately occluded and the vein graft stump is seen in the aorta occluded and there is no flow to the circumflex and the right coronary artery area except through the LMA and LAD collaterals but this vessel is excellent with an excellent anastomosis it also shows that the Right coronary artery the vein graft stump is seen in the aorta occluded and there is no flow to the circumflex and the right coronary artery area except through the LMA and LAD collaterals. None of the vessels are even amenable to PCI.
2- Blood test ( please find the attached full and detailed report  )
Showed that most of the test are normal but calcium total (result 2.13, range 2.15-2.55) and platelet count (result 144, range 150-500) are low abnormal
3- Echo report ( please find the attached full and detailed report )
Showed the following:
a. (EF) Ejection fraction : 35-40%
b. Chambers: RV and RA: are normal size and function, LA: dilated, LV: mild degree concentric left ventricular hypertrophy. No SAM, mildly dilated left ventricular activity.
c.   Valves : PV: structurally normal , TV :structurally normal with trivial tricuspid regurgitation , AV mildly thickened sclerotic, no significant gradient across, MV: mild mitral regurgitation center jet
d. Pericardium : normal Pericardium with no effusion
e. Vessels : aorta : normal aorta root , IVC : Normal size
Advice: patient need aggressive medical therapy and quit smoking.
Request: the Patient need to find answers to his following concern:
1- What was the reason for this raised enzymes that affect the cardiac for the next time
2- Is there any way to raise the  Ejection fraction to be 50% or above
3- Can the Patient make another bypass surgery
4- Overall , what can be done with  Patient to perform his cardiac activity
Thank you , majd alsaadi

[ed34]

what you really need is a nuclear perfusion scan.

[malsaadi]

Can I send you the echo, blood and angio reports  to give more deep feedback and also I would like to add one comments , he stop smoking be the the main concerns is how to raid the EF from 40% to 50% to be almost normal

[ed34]

The likely cause for this is the smoking. From the report, the whole heart is just receiving blood from one vessel, the grafted Lima. The left main stem is blocked which feeds the circumflex and LAD but these are blocked anyway. The Right artery is blocked. I cannot understand one part of the report, which mentions collaterals. I suspect it means that the circumflex is getting no blood, hence the drop in EF. However the RCA is getting a collateral feed from the LAD, thanks to the Lima.To be honest, I think a bypass would be a waste of time while the patient is smoking. However, more information is required before any decision can be made. The problem vessel is the Circumflex, and if it has no blood, then it is likely a lot of heart muscle has become necrotic (died). This is something that the cardiologists need to establish. If the muscle is not necrotic, then perhaps bypass could be viable, but certainly not while smoking.