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326176 tn?1239519289

Need For Angioplasty

I am male,of 57 yrs.I had a heart attack on 10th Oct. 2007. DIAGNOSIS: CAD- Acute Exterior AWMI lysed with SK . Not good reperfusion.LV dysfunction-early LVF.  Recurrent  primary VT  reverted with DC Shock .ECHO - MV opening restricted due to high LV EDP .  Mild MR,whole of IVS apex anterior wall, Diskinetic poor function,No thrombus,No effusion.AWMI acute.Poor LV function.  
Course in the hospital::Since there was no contra indication,patient was thrombolysed with Streptokinase,Dobutamin and Dopamin support given also treated with Antiplatelets,Statins,Inj.Clexane,Carvedilol and Insulin. During lysis patient had haemodynamically unstable VT-recurrent episode each time reverted with DC shock.Patient had feature of early LVF in the form of Tachypnoea and bilateral basal crepts during lysis,treated with Inj.Lasix.
                            Patient later stabilized with stable vital signs. Dobutamin and Dopamin tapered with stopped. Stable at shifting out of ICU.
                             After a week's  stay in the hospital I was discharged and advised medications such as DEPLATT -A ,STATOR,CARDIVAS,EPTUS,LASIX,NITROCONTIN. To stabilise my diabetic condition I am advised Inj. Human Mixtard and Tab. Glimi. A t present I m taking rset at home with periodic check-ups  with my cargiologist consultant                                  
                              In this regard I would very much appreciate your kind gesture of evaluating my case and record your precious comments and suggestions.I would       like to know in particular whether I would be subjected to Angiogram test and   ensuing angioplastic procedures.I will be grateful beyond measure for your kind response.Thanks......                  



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11 Responses
214864 tn?1229718839
My dear friend Sukumar, this is not the board where Doctors answers questions. I think maybe you think it is. You can reach the Heart Question Doctor's board easily from here. Just click on forums and the forums at the top of the page are the Doctor's forums. This is the patient's forum.

Having said that, I will try to help you as it is hard to post on the Doctor's heart forum. Best time to try is 5-6 am GMT-6 or 7.

You have had a massive heart attack, unless you have had serious heart problems before. The 2 most serious issues you face is ventricular tachycardia (VT), which has almost killed you while in the hospital, re: "Recurrent  primary VT  reverted with DC Shock" and "During lysis patient had haemodynamically unstable VT-recurrent episode each time reverted with DC shock".

Your other problem is that your coronary arteries have not be imaged by an angiogram. If you could have an angiogram, serious blockages could be repaired by stenting, which may "reperfuse" or allow or increase blood flow to areas of your heart that are in very bad shape as of now, re: anterior wall myocardial infarction ( AWMI) Not good reperfusion.LV dysfunction-early LVF". This means you had a heart attack effecting the anterior wall of your heart (AWMI), and you have left ventricle failure.

Sometimes heart muscle is "stunned" or in "hibernation" after a heart attack. If blocked coronary arteries can be opened either by stenting or bypass surgery, this heart muscle can return to a normal, or at least a better functioning state.

I have checked all of the drugs you have listed, and have not found a medicine for an arrhythmia, which I was looking for. I can not find any information on "Stator".

It seems you definitely need an implanted defibrillator, or ICD, due to the ventricular tachyardia, which is the most dangerous of all arrhythmias. Do you have a defibrillator at home?

Some results of your echocardiogram: "ECHO - MV opening restricted due to high LV EDP .  Mild MR,whole of IVS apex anterior wall, Diskinetic poor function,No thrombus,No effusion.AWMI acute.Poor LV function".

Your echo shows that you have diastolic failure due to the high LVEDP (left ventricle end diastolic filling pressure) and it is causing your mitral valve opening to be restricted. This causes poor filling of your left ventricle, or the "big pumper".

You also have mild mitral regurgitation (MR) which is reverse flow from the left atrium into the pulmonary artery (instead of the opposite) and can cause pulmonary hypertension and clotting if it becomes bad enough.

You have poor diskinetic or hypokinetic function of your entire interventricular septum (IVS) apex interior wall. The apex is the bottom of your left ventricle. The interventricular septum is the wall that divides your left ventricle from your right ventricle. Again it is noted that you have poor left ventricular function and have had the acute AWMI.

No thrombus (blood clots) or pericardial effusion (heart is contained in a sac within a sac, the pericardium and there is no leakage into this space between the 2 sacs).

I wonder what your Ejection Fraction is. This fraction shows overall, how well your heart is performing. It is very reliable unless your particular type of heart failure has a preserved EF. In your case with LV failure, I don't believe your EF would be preserved or misleading.

Maybe your doctors are afraid you are not well enough to have a cardiac catheterization to perform an angiogram at this time. Your heart is in very bad shape, BUT you can recover Sukumar with the right medications, repairing any blocked coronary arteries by either stents or bypass, and by rehabilitation. I would immediately start a low or no salt diet. Your heart cannot handle this. You also need to be taking a beta blocker known as Coreg, if you can get it.

I hope that I have helped a bit. If not, ask questions. Best of health to you,

Jack
214864 tn?1229718839
I would very much appreciate your kind gesture of a response of some type.
326176 tn?1239519289
I'm really sorry I could not put up a response much earlier  just because of a herpes problem which  left me with painful lesions  in the right  upper lip.                                                         Apart from the knowledge that I am recovering from a heart attack, my awareness about the course of treatment that is being followed and the various types of medications administered  is limited. I am finding that your learning about cardiac ailments is of a high acumen.                      I hope my heart condition would repair itself with regular medications and rest. But I'm not quite sure whether my diabetes (ppbs - 250) level would pose any serious threat to my condition. I have type 2  diabetes...on insulin inj twice a day.    please reply when you get enough time . All the very best to you ....sukumar.
326176 tn?1239519289
   About the EF(ejection fraction) you have enquired about in the last post ...my Echo  picture records it as 26.03% . The echo was taken on 20th october 2007 while I was in the hospital bed. Is it normal or does it show any concern . I would  be glad to know.   Sukumar  .........
214864 tn?1229718839
Your EF is very low. I would think that if you had it measured again by an echocardiogram or angiogram it would be higher. A normal EF for our age is around 50%-65%. In the US, one prerequisite for social security disability income is an EF of <30%. So sorry to give you bad news, but like I say it can improve over time, if you receive the proper medical treatment.

I am not familiar with blood glucose measured in parts per billion (ppb). In the US we use the decimal: milligrams per deciliter (mg/dL).

Europe uses metric: millimoles per liter (mmoles/L).

If your blood glucose is high, it will have a very negative impact on your recovery. You need to ask about increasing your insulin, if that is possible and follow a strict diet. This trauma and possible blood glucose given to you while you were in the hospital could have caused an exponential increase in your blood glucose.

I just hope that you are aware that the heart supplies it's own fuel, that is to say that when the heart rests and the muscles relax after a beat, blood flows from the output of the heart into the coronary arteries which supply fresh, oxygenated blood with nutrients to all of the heart muscle and valves. Interruption of this blood flow due to plaque or blockages can cause a heart attack. You could still have serious blockages. Do you have severe angina or chest pain? If so, that is indicative of more blockages. I have had 10 angiograms :) They are a piece of cake. Getting my teeth cleaned hurts more!

If you are not physically able to have an angiogram performed, then there are other non-invasive coronary artery imaging techniques available in the US and I would bet they are in India also. They are the latest MRIs with the most powerful magnets, and the 64 Slice Coronary Artery CT Scan.
326176 tn?1239519289
I had a check up with my cardiologist yesterday. She suggested a couple of more week's rest  and medications. Moreover insulin  unit of injection has been slightly increased to stabilise my blood sugar level which is at present 160 mg/dl during post prandial monitoring. I am not experiencing any sort of uneasiness and feeling quite comfortable and pleasant. Do you feel that  I can return to normal activity in a few weeks' time.?
214864 tn?1229718839
Do you have strength and stamina? Do you feel "normal"?
326176 tn?1239519289
Hi Lack !         I cannot definitely say that I am in full strength and vitality. Yet I have a feeling that I am much better now. I have not put my stamina level to any sort of test for fear of getting a bad condition. Do you think that  I will be hale and hearty with the present dose of medications  and will return to normal self very soon ?
326176 tn?1239519289
Hi Jack !         I cannot definitely say that I am in full strength and vitality. Yet I have a feeling that I am much better now. I have not put my stamina level to any sort of test for fear of getting a bad condition. Do you think that  I will be hale and hearty with the present dose of medications  and will return to normal self very soon ?
214864 tn?1229718839
I sure hope so Sukumar, but who knows what lies within your coronary arteries? Are you afraid to have a cardiac catheterization? I have had 10 and I would rather have a cath than get my teeth cleaned! They are a piece of cake. No pain at all except for the tiny numbing shot. The arteries have no feeling! If you had one, you would know much more about your future. Are you aware of the anatomy of the cardiac circulatory system?
326176 tn?1239519289
  No , not at all ..I'm not afraid of cardiac catheterization. In fact I'm quite anxious to know about  blocks, if any, in my coronary arteries  and clear them. I'm really concerned about  healthy living no matter  how many days or months I  have left to exist in this world.   I wonder my cardiologist does not even mention about an Angio ?
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