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Suggestion for Angiogram - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Excellent Posted in: Heart Attack
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2408 Questions
Doctor :   Hi
Doctor :   How can I help you?
Doctor :   Are you there?
User :   My mother on sunday early morning suffered a massive heart attack. She is a diabetic patient, with a history of high sugar levels. Her kidneys are presently functioning to the extent of 60%.
Doctor :   Ok
User :   Two months ago, she fell down and we found she is suffering from osteoporosis. She had to undergo a surgery for her dislocated shoulder bone. But since her shoulder bone was fractured, doctors removed a bone from hip and operated upon her
Doctor :   Ok
User :   This was in Mid August, but she has been unable to fully use her leg and hand and needs help even to go to loo. At night she is on diapers. Three weeks ago, we took a second opinion from a ortho surgeon, who suggested that she seems to have suffered a stroke and is slowly recovering. We have kept a physiotherapist to do some exercises for her hand and leg. And now she had this massive attack last sunday. She is in ICU and docs have said she will be shifted to ward tomorrow. Opinion of Cardiologist is that she should undergo angiography to detect blockage in the blood vessels. There is another cardio, know to my family who has said that in her condition, invasive surgery is not recommended considering her renal condition, diabetes and stroke in the recent past. Please advise
Doctor :   Before we proceed further, I am sorry for your mom and wish her speedy recovery from the present situation.
User :   Thank you doctor
Doctor :   May I ask a few more details about your mother so that I can provide you with a better opinion.
User :   sure
Doctor :   May I know her age?
User :   68 years
Doctor :   Apart from diabetes/hypertension and the osteoporosis, does she have any other medical problems such as hypertension. previous cardiac problems in the past?
User :   no
Doctor :   Ok
Doctor :   Is your mother on dialysis for the kidney problems?
User :   In fact, she is suffering from diabetes since she is 40-45 years of age and has always had levels of 500-600 sugar levels. She is a house wife and was taking daonil as medicine. She has never been checking her sugar levels any time in the past. She also had to get her thumb toe and the half of the next toe amputed because of gangrene. In 2005, she had urinary infection and was in a critical condition in hospital for about a month.
Doctor :   Ok
User :   No she is not on dialysis. Sorry this is a long story. In 2005, docs said she was suffering from thrombosis, a blood clot condition, affecting one in a million people. She had a low platelet count and was given 88 bottles of blood. At one point, a kidney specialist put a stent in her kidneys to improve its functioning and told us that the stent would need to be removed in six months. But we forgot all about the stent, in our excitement of getting her out of hospital. Last year she kept complaining of abdominal pain and further tests revealed presence of an infected stent. This was subsequently remove and I guess her present kidney condition could either be because of high diabetes levels or the presence of the infected stent in her kidneys for nearly four years.
Doctor :   Ok
Doctor :   Let me brief you now.
Doctor :   As you know, myocardial infarction (heart attack) is a condition that occurs due to thrombosis and block of the coronary blood vessels.
Doctor :   Angiogram is a procedure that is done to determine the percentage of block and the areas of coronary arteries that is blocked.
Doctor :   Treating this block is important in preventing further heart attacks from occuring.
User :   ok
Doctor :   Now in the present circumstances, the immediate care has to be towards treating the present heart problems, high sugar levels, her kidney state.
Doctor :   Since the stroke was a minor one and has been improving, its affect on the present condition and its role in deciding the type of treatment needed is not as significant as diabetes and kidney problems are.
Doctor :   Hence the immediate treatment has to be directed in getting her sugar levels under normal, stabilising the heart and maintaining the kidney functions.
Doctor :   Are you following?
User :   ok
User :   sure.
Doctor :   If they are controlled, then the next step is to determine the blockages by doing an angiogram.
User :   i understand
Doctor :   At this point, I would also like to bring to your notice, that since angiogram is a procedure involving the use of a dye, which can affect her kidney functions more.
User :   so this is can be risky
Doctor :   and she may need dialysis if necessary depending on the kidney functions.
Doctor :   The role of this procedure (angiogram) will be decided based on its necessity and the kidney functions.
User :   ok, so this will be the call of the cardiologist
Doctor :   Yes, this will be the call of the cardiologist who will be treating her, but based on my experiences,
Doctor :   a angiogram, if its absolutely necessary can be done, in a 65% functioning kidneys - with the use of dialysis.
Doctor :   Angiogram is just a diagnostic procedure and based on its reports either open heart bypass surgery or an angioplasty/stenting may be needed.
Doctor :   You can opt for stenting procedures if feasibleas they are minimally invasive and are as effective as bypass surgeries or angioplasty, and they are not as cumbersome
Doctor :   as the open heart surgery is.
Doctor :   Have you followed what I have suggested?
User :   Yes doctor, thank you so much, I am much more informed know as you have explained this is a very simple manner
Doctor :   I suggest you to discuss these options with her treating cardiologist, once she is stabilised and her sugar and kidney problems are brought under control.
Doctor :   Do you have any other query?
User :   sure doctor, thank you once again, no doctor this is all, but depending on your convenience, I wanted to check with your regarding cholestrol, would be free to discuss the same or have i taken a lot of your time
Doctor :   You are free to proceed with your queries
User :   Thank you doctor.
User :   My husband recently had a problem of epistaxis in September, he was admitted for about three days. During the course of conducting a battery of blood tests, we realised his cholestrol levels were high.
Doctor :   Ok
User :   Recently about ten days back, we visited a cardiologist, who wanted us to conduct three more specific tests pertaining to Indian conditions. These tests were Serum Homocysteine level- observed value > 50 (Range 5 to 15)
Doctor :   Ok
User :   Lipoprotein A- 180.6 mg/DL (Range upto 30) and High sensitivity CRP 2.15 (Average range 1- to 3)
Doctor :   Ok
User :   The cardio mentioned he had not seen such high Lipo A levels in his career and mentioned it is a hereditary problem
Doctor :   Ok
User :   That the body was not producing necessary enzymes to control the cholestrol. So has suggested medication- Rozafel and Rabonik and Cap NO CAD. My husband has been advised by his ENT surgeon that not to take these medicines since these not only have sidefffects but also will need to be taken life long once started. Therefore need your advise on this doctor
Doctor :   May I know the age of your husband?
User :   38 years
User :   No smoking and drinking habit, weight is 84 kg
User :   Used to regularly exercise- gym and yoga
Doctor :   Ok
Doctor :   Let me brief you.
Doctor :   Cholesterol levels are affected by various factors.
User :   sure
Doctor :   The factors affecting them are age, obesity, dietary factors, sedentary life style, lack of exercises, liver disorders - both acquired and congenital, alcoholism and so on.
Doctor :   High levels of cholestrol and homocysteine levels cause increase in the chances of strokes and myocardial infarctions.
Doctor :   Hence its necessary to get the levels under control.
User :   ok
Doctor :   Cholesterol levels can be controlled by lifestyle changes, reducing weight, avoiding alcohol and by drugs belonging to the class of statins.
Doctor :   Yes, the drugs may have to be used regularly and for life time sometimes, but they do not cause significant side effects.
User :   But I understand Statin causes side effects like weakening of muscles
Doctor :   Few side effects that are reported are nausea, vomiting, constipations.
Doctor :   Muscle pain and weakness are less common.
User :   But will taking the medicine actually lower the chances of getting a heart attack
Doctor :   These medications lower the cholesterol levels by reducing the absorptions and by increasing the metabolism.
Doctor :   Reports of heartattacks and strokes are higher in those who have high cholesterol levels.
Doctor :   Hence, use of these medications definitely lower the chances of strokes and heart attacks.
User :   In case he were to regularly exercise and control dietary habits will the levels decline
Doctor :   Yes, with regular weight reducing exercises, dietary habits and avoidance of alcoholic products, can lower the levels of cholesterol.
Doctor :   However very high levels of cholesterol is an indication for the use of statins.
User :   ok doctor
Doctor :   If you do not wish the use of the statins, I would suggest a strict life style modifications, restricting high calorie and oils, weight reducing exercises,
Doctor :   avoid alcohol and regular cholesterol check ups.
Doctor :   If the cholesterol levels are high inspite of these measures, then consider the use of statins.
Doctor :   Homocysteine levels are not related to
Doctor :   I mean may not be related to high cholesterol levels.
User :   Fine doctor
Doctor :   They occur due to imbalance in methionine metabolism which inturn are affected by vitamin deficiency.
Doctor :   The treatment is such are the use of multivitamins containing folic acids.
Doctor :   Since vitamins do not cause such side effects, I would recommend the use of folic acid and other multivitamins.
Doctor :   Have you followed what I have suggested?
Doctor :   Are you there?
User :   Yes doctor
User :   I got a call from my brother
User :   The cardio has also suggested folic acid, which among the medicines I asked pertains to folic acid
Doctor :   I would also recommend you to use the option of get a diet plan and speak to our nutritionist, who will be able to help you in a proper diet control to maintain the cholesterol and homocysteine levels under control.
Doctor :   Yes, folic acid is a vitamin and is useful in controlling homocysteine levels and can be safely used.
User :   Sure doctor, thank you so much
Doctor :   Have you followed what I have suggested?
Doctor :   Do you have any other query?
User :   I have found our chat very useful doctor. Meanwhile one last question regarding mother, in case dialysis is done whilst doing angiogram, will dialysis need to be done now regularly
Doctor :   She may need a few dialysis in the beginning stages, probably for few months(4 to 6 months),
Doctor :   Depending on the renal condition later, the need for dialysis will be decided.
User :   ok doctor
Doctor :   Do you have any other query?
Doctor :   Are you there?
User :   No doctor, that will be all, thank you so much, may i know your name doctor, for future guidance on this subject
Doctor :   Bye for now.
User :   Bye doctor
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