What is the alternative treatment for ICD?

Question

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.

Answer 1

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.

Answer 2

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.