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Had MI and recovering. Multiple blockage, bypass not possible as heart is weak. Why does she have suffocation?

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Hi, my mother recently had MI and is recovering. The doctor said that she has multiple bloackade but bypass isn't possible as her heart and condition is week resulting from a scar in her heart. Mama usually experience suffocation like problem at night of if she has heavy food. She has gastritis and is detected with h. pilori infection. We are confused so as what could be the reason. If it is heart or gas? How do we proceed her treatment.
Posted Sat, 26 May 2012 in Hypertension and Heart Disease
Answered by Dr. Ravindra L Kulkarni 1 hour later
Thanks for writing in.
Since your mother has multiple blockages in the coronary arteries and has recently suffered from a heart attack, she definitely needs a bypass surgery. However, we usually advise that the surgery be done atleast 2-4 weeks after a heart attack as cardiac enzymes are raised. Also as left ventricular ( part of the heart which pumps blood to the rest of the body) function is poor due to scar at present, she is not fit for surgery.
The complaints that she has following a meal are similar to angina in which the blood supply to the heart is decreased following exertion ( physical or mental) or heavy meals. At present, her plan should include,
1. She should take as much rest as possible.
2. The drug treatment she is receiving should be optimised and more potent antianginal drugs need to be added.
3. Frequent small meals are advised. She should avoid heavy meals
4. Antacids and proper treatment for H. pylori infection is also advised. She needs to be started on an antibiotic regimen and a course of proton pump inhibitors like omeprazole. antacid and drugs for acidity are also needed.
5. A repeat echo study of heart needs to be done after 4 weeks to assess functioning of heart.
6. She needs a consult with a cardiac surgeon in some time regarding risk and benefits.
7. Proper lifestyle modification and diet counselling needs to be done by a rehabilitation expert.

I hope I have addressed your concerns. I shall be available for follow ups.
Wish her a good health.
Above answer was peer-reviewed by
Follow-up: Had MI and recovering. Multiple blockage, bypass not possible as heart is weak. Why does she have suffocation? 6 days later
Dear Doctor,
Mama is taking medicines - clopilet A-75mg,cardace 2.5, metolar,nitrocontine2.6mg(bd),atorvas 10mg for heart and sompraz & pan dsr with gelusil for gastritis. I still have the following querries -
1. Is surgery not possible in future? In this case ,what about the blockages ?
2. Won't stenting help a little?

At least, we wish that mama is comfortable and able to sleep properly 6-8hrs at a stretch, which she isn't getting. Kindly advise about the breathlessness and lying down problem.

Best regards
Answered by Dr. Ravindra L Kulkarni 5 hours later
Thanks for the treatment update.
1 I really appreciate your concern and aim of the treatment is always to improve quality of life.
As she has multiple blockages bypass surgery is first option. As discussed earlier we have not ruled out that option completely. It is only a matter of stabilisation of heart status, heart enzymes within normal range, we can plan bypass surgery.
Detail pre-anaesthetic check up will also tell us the risk involved in surgery.

2 in case surgery option is not possible due to poor cardiac fitness about very high operative risk, option of angioplasty with stent can be considered. In this you need to discuss angiography report with your cardiologist.
In such cases most critical lesion or the lesion which caused heart attack is addressed with stent. This definitely improves heart functioning and stabilises patients symptoms.

3 your cardiologist can take decision on which lesion needs stent on priority basis.

4 Regarding treatment details, your mother is on good line of treatment. You can discuss addition of diuretic drugs in treatment with your cardiologist. This will help to control breathlessness and will also improve heart functioning.

5 In this era of better technology and expertise we definitely can take decision about bypass surgery or angioplasty. Let your cardiologist decide which method to select and its timings. It will be in the best interest of your mother.

Hope this will give you confidence in your mother s treatment.
Above answer was peer-reviewed by
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