Dr. Muhammad Zohaib Siddiq
Cardiology
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Patient's Query
Hello doctor,
My mother’s age is 80+ and she had heart attack four times. Two attacks in quick succession a year back and two attacks quick in last one month. Her heart pumping capacity is about 35 % with kidney creatinine 3.4 mg/dl. But it is decreasing now. She never had diabetes. But always when admitted to hospital for heart attack treatment, her sugar level increased a bit and hospital always started giving her Insulin. Last one and half year her cardiologist never advised her to go under any aggressive treatment like doing angiogram and then further treatment like angioplasty and ect. If we go for angiogram followed by further treatment like angioplasty and ring fixing. Will it be safe for her? Will she be able to survive? Traditional angiogram or CT angiogram and then angioplasty or ring.
Hi,
Welcome to icliniq.com.
Although bypass or angioplasty can be done in old age, if the health of patient is promising, but if other health issues are present then it becomes a high risk case. As your mother's kidney function is poor, it becomes very risky to have an angiogram done because even non-ionic contrast medium is detrimental for the kidneys. One possibility is that have her 1 or 2 sessions of dialysis done first, then go for angiography and angioplasty and again have one or more sessions of dialysis in close liaison with good nephrologist. If this is done safely, then next risk is of bleeding. After angioplasty, blood thinning medicines are given for long time, this may cause bleeding problem in old age. Regarding bypass, it is a major surgery and needs general anesthesia, although not impossible in old age but, it depends upon overall health and organ functions of body. Cardiac anesthetist will fully evaluate her before bypass. Third option is to keep her on medicines only without going for any intervention. In my opinion, consult a nephrologist that is there any chance of recovery of kidney function, if no then periprocedural dialysis can be considered.
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Cardiology
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