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What is the alternative treatment for ICD?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hi doctor,

My father is 59 years old. Eight years back, he had a heart attack, and the next year he underwent CABG. Presently, he is feeling uncomfortable and got an angiogram and cardiac PET or CT imaging done. It stated that he has severe LV dysfunction of more than 30 percent. He also has a severe cough. Along with these tests, he also got a chest x-ray and a blood test. Now, the doctor has suggested that they undergo ICD and lifetime medication. Please suggest an alternative to improve his heart condition.

Thank you.

Answered by Dr. Prashant Valecha

Education:

MD Physician

Professional Bio:

Dr. Prashant Valecha is a General Practitioner and an expert in Preventive and Noninvasive Cardiology and completed his MD Physician from Yerevan State Medical University, Armenia, in 2009. He is an expert in treating all cardiac ailments. He has 14 years of clinical experience and is currently practicing in Bhopal.

This doctor is not available for online consultations on the platform anymore.

Hi,

Welcome to icliniq.com.

These procedures in modern science are done according to guidelines. So according to ACC (American College of Cardiology) or AHA (American Heart Association) guidelines, indications for ICD (implantable cardioverter defibrillator) placement are under two broad categories as follows: secondary prophylaxis against sudden cardiac death and primary prophylaxis.

For secondary prophylaxis, ICD placement is indicated as initial therapy in survivors of cardiac arrest due to VF (ventricular fibrillation) or hemodynamically unstable VT (ventricular tachycardia). Published guidelines exclude cases in which there are completely reversible causes, such as primary prophylaxis, although this exclusion is somewhat controversial.

Currently, indications for primary prophylaxis account for most ICD implants, even though the evidence for such implants is often less well-established. Class I indications that the benefit greatly outweighs the risk and the treatment should be administered are as follows: Structural heart disease, sustained VT and syncope of undetermined origin, inducible VT or VF at electrophysiological study (EPS). Left ventricular ejection fraction (LVEF) <35% due to prior MI 9 at least 40 days post-MI (Myocardial infarction) NYHA (New York Heart Association) class II or III, LVEF ≤35%, NYHA class II or III, LVEF ≤30% due to prior MI, at least 40 days post-MI, LVEF < 40% due to prior MI, inducible VT or VF at EPS. So your father's case comes under this.

Still, there are no ECGs showing VT/VF (life-threatening arrhythmias), but the ICD will prevent those as there are chances for that. When we wait and watch for VT/VF (some people do that), the chance of sudden cardiac death is high. No alternative for ICD. You can still wait and watch if breathing symptoms and EF (ejection fraction) are improving with medicines.

I hope this helps.

Please revert so I can assist you further.

Thank you.

Patient's Query

Hi doctor,

Thank you for your reply.

He has had a severe cough for the past 20 days. It is not subsiding. Is this also because of the current condition? Please help.

Thank you.

Answered by Dr. Prashant Valecha

Education:

MD Physician

Professional Bio:

Dr. Prashant Valecha is a General Practitioner and an expert in Preventive and Noninvasive Cardiology and completed his MD Physician from Yerevan State Medical University, Armenia, in 2009. He is an expert in treating all cardiac ailments. He has 14 years of clinical experience and is currently practicing in Bhopal.

This doctor is not available for online consultations on the platform anymore.

Hi,

Welcome back to icliniq.com.

Yes, it can be related. Because, when heart pumping function decreases after heart attack, patient's lungs get congested by fluid that may cause cough with phlegm. But, with medicines like tablet Furesomide, it will decrease. If he has dry cough, then syrups like Codeine 5 ml will help. But, Codeine can cause sedation.

I hope this helps.

Please revert so I can assist you further.

Thank you.

Medically reviewed by Dr. K. Shobana
Published At March 6, 2017
Reviewed At September 25, 2024

Education:

MD Physician

Professional Bio:

Dr. Prashant Valecha is a General Practitioner and an expert in Preventive and Noninvasive Cardiology and completed his MD Physician from Yerevan State Medical University, Armenia, in 2009. He is an expert in treating all cardiac ailments. He has 14 years of clinical experience and is currently practicing in Bhopal.

This doctor is not available for online consultations on the platform anymore.

Education:

BDS

Professional Bio:

Dr. K. Shobana is a Dental Surgeon specializing in oral health and dental care. She is skilled in preventive dentistry and provides oral hygiene education. She can do restorative treatments such as fillings and crowns. She can handle periodontal problems such as gum diseases and periodontitis. She can do root canal treatment.

This doctor is not available for online consultations on the platform anymore.

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Education:

MD Physician

Professional Bio:

Dr. Prashant Valecha is a General Practitioner and an expert in Preventive and Noninvasive Cardiology and completed his MD Physician from Yerevan State Medical University, Armenia, in 2009. He is an expert in treating all cardiac ailments. He has 14 years of clinical experience and is currently practicing in Bhopal.

This doctor is not available for online consultations on the platform anymore.

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