I am a cardiac patient with 50% block in LAD. Please help.

Hello,

Welcome to icliniq.com.

I understand your concern.

Do you have any symptoms at present? What all medications are you on? Do you have any previous ECGs (electrocardiograms) for comparison? When was this angiography done? Any follow-up testing for blockages? I have seen the ECG report (attachment removed to protect patient identity). It is sinus bradycardia early repolarization pattern, T wave inversion in AVL (augmented electrocardiographic leads), and no other significant ST-T abnormalities seen. In simple terms, the heart rate is slightly on the lower side. There are some changes in the ECG, which is considered a variant and is not considered a significant finding, especially if one does not have any symptoms. So your ECG is largely fine, with some minor changes. You do not need any particular treatment based on ECG itself, and it is not worrisome. However, considering your 50 percent stenosis, these blockages need to be regularly followed up with testing, like treadmill tests and ECHO (echocardiography). You should be on a blood thinner like Aspirin or Clopidogrel on a long-term basis. Avoid oily fatty food. Do regular exercises like walking or brisk walking. However, avoid heavy activities. Regular monitoring of BP, sugars, and lipid profiles is a must.

I hope this helps.

Warm regards.

Hello,

Welcome back to icliniq.com.

I understand your query.

A little more information I asked for above, and investigations like angiography report and previous ECG would have helped me guide you. If your angiography was done a long time ago, you should have an ECHO, and if your ECHO is normal, then take a treadmill test to rule out the possibility of cardiac pain. If angiography is recent, then the pain is unlikely to be cardiac because 50 percent of blockage does not cause pain. Now cardiac pain classically occurs on exertion and relieves with rest. Intermittent rest and pain for a few seconds are usually due to acid reflux. However, to be sure, the above tests should be done.

Hope this helps.

Regards.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Now if we go with previous angiography (attachments are hidden to protect the patient's identity), then 50 percent would not require angioplasty, and only medications would be enough, which were going on. However, it is possible that blockages have now worsened over the last three to four years and causing pain. So you will need certain tests to check the status of the blockages. Now if your pain is classically cardiac occurring during activities and relieving with rest, then better to go for a conventional angiography to confirm the severity of the blockages. If pain is occurring at rest only and is not much related to activities or exertion, then you may go for an ECHO and stress test like a treadmill test. If the treadmill is negative, then nothing to worry about, and if positive, then you will have to go for angiography. Now regarding your current reports, sugar, lipid profile, and liver enzymes are deranged. You have not mentioned cholesterol medications like Atorvastatin or Rosuvastatin, which we can add to your current medications. However, if the doctor had stopped it due to liver derangement, then it should be restarted after its resolution. The probable reason for derangement is fatty liver, so if you are overweight or have abdominal obesity, then I suggest you should focus on weight loss. It would help in resolving liver damage, and sugar or cholesterol derangement will settle down. You should get these parameters rechecked after three months. The rest of your medications are fine and should be continued. Avoid sweets, focus on calorie restriction, and have a very light dinner.

Hope this answers your query.

All the best.

Hello,

Welcome back to icliniq.com.

I understand your query.

I suggest you start with Atorvastatin 10 mg and later will need to increase if enzymes do not rise. So after starting Atorvastatin, you need to get liver enzymes repeated after one week. If there are no further elevations, then you should continue it. Regarding liver enzymes, we need to find the cause first, and it is probably fatty liver in you. We need to confirm it and rule out other causes. Weight loss will be helpful. I suggest you consult a gastroenterologist for additional medication and undergo an ultrasound of the liver to confirm fatty liver and HBsAg (hepatitis surface antigen), anti-HCV (hepatitis C virus) test for viral infection of the liver, especially if not had in last few months or years.

Hope this helps.

Regards.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Alright, so it is confirmed. It is a fat deposition, and the best treatment is calorie restriction, regular walking, and weight loss. Besides this, gastroenterologists may advise vitamin E supplements for the same. So, discuss it with them once.

Revert in case of queries.

Regards.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Yes, you will need to be on Statin in the long term to keep cholesterol under control and slow down the progression of the blockages.

Revert in case of queries.

Kind regards.