The doctor has advised my mother for a pacemaker and angioplasty. How should I prioritize?

Hello,

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According to your query, two vessels are diseased. Her heart rate went to 30, and she fainted after taking BP (blood pressure) medicines. Why angiography was done? Did she have heart attack or just uncontrolled angina? What medicines is she taking for BP and diabetes? Is she under any other medicines for heart issues? Please answer these so that I may guide you accordingly.

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If there is a heart attack, NSTEMI (non-ST-segment elevation myocardial infarction), angioplasty is done within 24 hours of a heart attack. If there is no heart attack, then only medicines are prescribed. A heart attack is diagnosed either with ECG changes or blood tests like cardiac troponin levels. But there were no changes in the ECG (electrocardiography) attached (attachments removed to protect the patient's identity). Was cardiac troponin positive in your mother's case? Get echocardiography done. If troponins is negative and echocardiography is normal, then my advice will be only medicines. If she has chest discomfort even after taking medications, then angioplasty can be considered. Regarding permanent pacemaker, why was it advised? Her ECG shows no block. Due to an overdose of blood pressure medicines, her heart rate may have decreased (beta-blockers decrease heart rate). But this ECG has a normal rate. If she does not have any previously known heart rate issues, there is no need for a pacemaker. She should take diabetic, hypertension, and heart medicines daily, without missing any dose. These medicines will be needed life long. If you have any concerns, please ask. I will be happy to assist you.

Hello,

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Echocardiography shows there was a heart attack in the past (attachments removed to protect the patient's identity). In diabetic patient, silent heart attack occurs, and it goes unnoticed. This is not a new heart attack as troponin I level is normal (negative) now. She has no symptoms of chest pain, so no need for angioplasty. Only medicines are needed now. If she has chest pain even after taking medicines, then angioplasty will be needed. Remember, angioplasty is only beneficial in case of a recent heart attack. Another indication of angioplasty is when the left ventricular function is low (in your mother's case, it is 45% lower than normal). Angioplasty is supposed to increase its function, but this can be predicted from echocardiography (in your mother's echocardiography, it seems unlikely that function will increase). If MPS (myocardial perfusion scanning) shows reversible ischemia, then angioplasty can be done to improve the heart's function. This ECG shows a second-degree AV (atrioventricular) block, but the heart rate is normal. If this ECG is persistent, then a pacemaker will be required. Sometimes block reverts back to normal. If it does not revert in few days, then a pacemaker should be implanted as she will be given cardiac medicines which slow the heart rate. Her kidney function is also decreased, probably due to diabetes, and it will deteriorate even more after angioplasty. I suggest keeping her on medicines and observe her for three to six months with follow-ups, nephrology consultations, diabetes control, and lifestyle modifications. Nowadays, many newer medicines are beneficial for diabetes, kidney function, and also for heart function. With these medicines, the heart's function usually improves over months. I hope this was helpful.

Hi,

Welcome back to icliniq.com.

Metosartan (Telmisartan) 50 contains two medicines. One of them is Metoprolol which is used to reduce heart rate and is beneficial for heart patients. It is taken only once a day. Please ensure she has not taken it twice or thrice (some patients do this to control blood pressure, which is not recommended at all). Another medicine is Telmisartan which is for controlling blood pressure and is also beneficial in heart patients. CTD (Chlorthalidone) is a diuretic that increases urine production and thus decreases blood pressure. If her ECG is the same, it is recommended to monitor her in the monitoring room or HDU (high dependency units). In addition, she should take all cardiac and diabetic medicines except for rate-lowering medicines. I hope this was helpful.