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Bypass and angioplasty done. Recommending to go for angiogram. What should be done? Any ideas?

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Cardiologist
Practicing since : 1981
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Hello Doc,

My name is XXXXXXX my dad underwent bypass in 2006 because his TMT was +ve and then Angioplasty in 2009, 10 days back we did his TMT and found that its +ve again, so his current cardiologist Dr. T. K. Venkatesth is recommending a angiogram again. This time he wants to do it Apollo Hospital Bangalore, while his earlier surgeries were in XXXXXXX Heart Care Bangalore. So I want to know

1. Is TMT recommened for patients who have already underwent bypass
2. Why is my dad facing same problem every 3 yrs?
3. Is it a good option to change his cardiologist now?
4. If yes then can you recommend any good cardiologist in bangalore
5. Is Dr. T. K. XXXXXXX correct in his analysis? Should we go ahead with his suggestions?
6. Any recommended cardiologist in Apollo hospital bangalore?
7. My dad is a diabetic, and doctors have been saying that these attacks are silent, what is the reason that diabetics cant detect heart attacks?
8. My dad is been on strict diet and taking medicines regularly and walks for almost 2 hrs a day, but still why are we seeing problems?
9. What are the precautionary steps we should be taking to avoid this situation in future?

Thanks, XXXXXXX
Posted Sun, 19 Aug 2012 in Hypertension and Heart Disease
 
 
Answered by Dr. Anil Grover 20 hours later
Dear Mr XXXXXXX
Thanks for writing in.
I am a qualified and certified cardiologist. I read your email with diligence and picked your questions and answering each one.
1. Is TMT recommened for patients who have already underwent bypass.
Yes, very much. In fact some institutes do it regularly even without symptoms at fixed interval repeatedly.

2. Why is my dad facing same problem every 3 yrs?
Both in bypass and in stent implantation. The factors responsible for disease are not completely removed. For example if you are born with genetic predisposition to coronary artery disease, by passing a part of coronary arterial system will still leave grafts as well as native arteries still prone to disease. In stent, howsoever, good it may be it is foreign to human tissue and most of the normal vessels and grafts are still left both are prone to disease. So, each treatment is not permanent cure, it is a temporary treatment which at the most is effective for usually 8-15 years and in some cases as early as 6 months.
3. Is it a good option to change his cardiologist now?
The training for becoming a cardiologist that is to obtain a DM degree in India or board certification in the US is standardized. Unless, you have bad personal rapport or social consideration, objectively I do not see any point in changing doctors. Doctors work in good faith for the benefit of the patient. It is their interest too.

4. If yes then can you recommend any good cardiologist in bangalore.
If I were to choose one institute in Banglore, I will choose XXXXXXX XXXXXXX Baba Institute in Wakefield. That has limited capacity so XXXXXXX Heart Institute (Hridualya) is equally good.


5. Is Dr. T. K. XXXXXXX correct in his analysis? Should we go ahead with his suggestions?
Yes, of course. Only coronary angiography can tell you with 100% certainty whether there is disease and how much it is.

6. Any recommended cardiologist in Apollo hospital bangalore?
Dr XXXXXXX XXXXXXX

7. My dad is a diabetic, and doctors have been saying that these attacks are silent, what is the reason that diabetics cant detect heart attacks?

8. My dad is been on strict diet and taking medicines regularly and walks for almost 2 hrs a day, but still why are we seeing problems?

Has this and medications(if any) have brought his glycated hemoglobin below 7.5 (this test indicates diabetic control over last 12 weeks) then perhaps Diabetes is no longer affecting arteries as a risk factor. But there are other risk factors in coronary artery disease to contend with.

9. What are the precautionary steps we should be taking to avoid this situation in future?
If you tell me what all precautions you are taking then perhaps I can add -like you told about exercise and I want to know about HbA1C.
Looking forward to hear from you.
With Best Wishes


Dr Anil Grover,
Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
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