Dr. Sagar Ramesh Makode
Cardiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
Please find enclosed reports of my father-in-law. He got severe heart attack yesterday. Now he is bit stable. Need your help on how to proceed further. Should we go for angioplasty or bypass operation? What is survival chances if we go for bypass? Right now he is not listening and insisting to go home. We are trying to convince him about treatment but it will take some time. Is it fine if we wait for a month or so if he is not ready now?
Hello,
Welcome to icliniq.com.
How much is his ejection fraction? Risk of the procedure depends on the ejection fraction. If it is fine, say more than 45 to 50 percent then the risk of life in such surgeries is 1 to 2 percent. The preferable and better option for him is bypass surgery as he is diabetic and it is little difficult to do stenting in the lesion described. Also, the long term result would be better with bypass. Now, it should be as early as possible, because the lesion is critical and it is 95 percent. We cannot predict the future course, whether he will remain stable or get another heart attack due to it. Although, medicines work quite well to reduce such risk, but advisable to go earlier.
Patient's Query
Thank you doctor,
Here the doctor is saying his one of the artery is having swelling and no doctor will operate in such situation. He has started medicines to thin the blood. So his recommendation is to go for bypass after 15 days. Also, he recommended stopping this medicine before five days to operate. Is this alright? Can we go for bypass if the artery has swelling?
Hi,
Welcome back to icliniq.com.
This is not mentioned in the report. Blood thinners like Aspirin, Clopidogrel have to be stopped five days prior to surgery and doctor will start injection Heparin in these five days to reduce the risk. And this should be alright for him. Actually, swelling is layman term and you should ask him what is the technical term for it so that I can interpret. Otherwise, if the patient is stable, then waiting for a period of two weeks is fine.
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Cardiology
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