Is chest sinking and sweating serious in a 76-year-old?

Hello,

Welcome to icliniq.com.

I can understand your concern.

Your father needs a comprehensive evaluation and proper management. We need to rule out ischemia and investigate other causes of his symptoms. Since he is post-CABG (coronary artery bypass grafting), we should first rule out anemia. Also, carefully monitor for any blood sugar fluctuations, heart rate and blood pressure fluctuations, and electrolyte imbalances. I recommend a basic lab workup including:

Complete blood count (CBC), creatinine, serum electrolytes (the report you shared shows normal electrolytes), random blood sugar (especially when he experiences profuse sweating), and troponin I (if raised, it would point to recent major ischemia).

His electrocardiogram (ECG) and echocardiogram, especially the stress phase, show ischemic changes. Given his bypass surgery history, I recommend a stress myocardial perfusion scan. Based on those results, a coronary angiogram and graft study might be needed.

Regarding medication, Aspirin and Clopidogrel are fine and should be continued. Concor (Bisoprolol) is also fine and should be continued based on his heart rate. Please monitor his blood pressure. If it is high, he will need medication for it. Why is he not taking a statin (Atorvastatin or Rosuvastatin)? He has coronary artery disease and should be on statins. Why is he taking Apixaban? Based on the details you have provided, I see no reason to continue it. Please feel free to ask any further questions you may have. I am here to help.

I hope this helps.

Take care.

Regards.

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

Thank you for your reply. Regarding your father's transthoracic echocardiogram, it indicates segmental wall motion abnormalities in the inferior and posterior walls, which could be due to graft occlusion. These abnormalities can lead to secondary mitral regurgitation (MR), which, according to the report, is moderate at rest and becomes severe upon exertion.

There is no intrinsic valvular abnormality, confirming this is a true secondary MR, resulting from the segmental wall motion issues. The positive findings are that his cardiac chambers are not dilated, and his ejection fraction is within an acceptable range. At this point, I strongly recommend proceeding with the diagnostic workup we previously discussed.

There is a high probability that appropriate medical therapy and revascularization, aimed at improving any underlying ischemia, will lead to significant improvement in the mitral regurgitation.

I hope this information is helpful. I wish your father a swift recovery.

Let me know if I can assist you further.

Regards.