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meds vs stent vs redo bypass

My father had a heart attack 23 yrs ago followed by a quadruple bypass. He has taken great care of his health with exercise and healthy vegetarian diet. He had a stress test done in 1994 that was positive. He is 73 now. He had a dobutamin stress echocardiogram and the Dr interpretaion is as follows:

Patient had angina at peak stress;
Max heart rate 126 BPM and B. P. 150/70 mm Hg noted at peak stress of 40 mcg/kg/min dobutamine + 0.3mg Atropin. Patient is receiving seloken XL;
resting echo showed inferior wall hypokinesia, which worsened and became akinetic during angina and regressed to basal level during recovery;
All valves are normal except trivial MR peak stress;
Systolic function improved with increasing dose of dobutamine.

Conclusion: Test Positive for Inducible Myocardial Ischemia
                  Fair LV systolic function. Sinus Rythm. Normal Valves.

He is scheduled for a angiography on Dec 20. He has no symptoms at all. The Doctor will provide options and make recommendations. What are the informed, educated questions to ask and make the right decision on continuing meds vs stents vs redo bypass. My mother is a doctor and needs to ask the right questions to the surgeon and make informed, educated decision for my father.

4 Responses
976897 tn?1379167602
First of all, you say he has no symptoms? was this also the case during the stress echo when angina was produced?
When the heart was stressed, it was seen that the lower part of the heart had hardly any movement, which means it's impaired. I have no idea what "fair LV systolic function" means?
If this was my heart, I would be looking for a bit more than medication. Even before max heart rate the lower part of the heart has impaired wall movement. Haven't they suggested an angiogram or ct to see what the problem is with the coronary arteries? You can't even guess the best options until you have the full picture, and in this case you don't. I would push for images of the arteries to be taken so a proper plan of action can be focused on.
Avatar universal
Thanks for the reply. My father is scheduled for a angiogram on Dec 20th. So from the report u can tell that before max heart rate the lower part of the heart has impaired wall movement. What is safer - stent or redo bypass if those r the options.
Avatar universal
Besides being tired he has no symptoms like chest pain day-to-day. During stress test he did feel some pain and raised his hand as instructed.

Thanks again,
976897 tn?1379167602
I would be a bit surprised if they suggest a redo-bypass, in most cases they revascularise the bypass vessels, or native vessels using angioplasty. I do emphasise the word MOST, which obviously doesn't mean all. It would be total guess work to which is the safest option without the angiogram results. If depends where the blockages are, how many there are and the size of them.
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