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Sugar level shot up, suffered heart attack. If blockage found, insert stent? Bypass better option? Suggest precaution?

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Cardiologist, Interventional
Practicing since : 1996
Answered : 192 Questions
Hello Doctor,

This is a question related to my mother – aged about 56 years.

Incident: She suffered a heart attack 15 days ago.

History: My mother is diabetic and her sugar has not been very well controlled. For some years, she also had problem in breathing while sleeping and breathlessness in climbing stairs.

Question: Around 20 days ago, her sugar level had reached 500 and had to be taken to a doctor. A few days after this sugar level had shot up, she suffered a heart attack. She was administered streptokinase and was taken to the hospital in Patna. The doctors mentioned that water has got inside her lungs and she has been admitted in the hospital ever since. The doctors are planning for an angiography in the next few days but will discharge my mother from the hospital tomorrow.

I am attaching her ECG reports and other reports taken after she was admitted to the hospital. I want to ask a few questions:

1. If a blockage is found in the angiography, shall we ask them to insert the Stent right during the angiography ?
2. Is bypass surgery a better option than stent in the case of my mother ?
3. Did this water collection in the lung happen before the heart attack or this happens as a result of heart attack ?
4. What are the precautions and the long time medication etc that can be suggested by the doctors in a case like this.
5. The doctors in Patna have advised that the water intake should not be more than one litre daily. Is there any precaution to be taken about the humidity level to be maintained in the room in which the patient will stay after being discharged ?

Posted Tue, 1 May 2012 in Heart Attack
Answered by Dr. Raja Sekhar Varma 18 hours later
Thank you for your query.
I am sorry for your mother and understand your concern.
In order for me to help you better, I would request you to upload the electrocardiogram and echocardiogram as a scanned image. You can use the “Upload your reports” section on the right.
1. If the blockage is more than 70% in severity and is in a critical location, and the blockage can be relieved by angioplasty, it can be tackled in the same sitting. This will relieve the patient, reduce hospital stay, prevent a second hospital admission and reduce costs.

2. The report of the angiogram, specifically the anatomy of the coronary arteries, will help us determine which of the two ( a bypass surgery or an angioplasty) is better for your mother. Surgery, nowadays, is reserved for those with multiple blockages not suitable for angioplasty and for certain types of blockages in certain locations. With the use of drug-eluting stents, angioplasty is equivalent or sometimes better than bypass surgery depending on the case. The decision has to be individualized.

3. It is likely that the water collection is a result of heart failure due to a weakened heart as a result of the attack and also due to uncontrolled diabetes.

4. The key components of long term treatment are control of blood sugar, control of the blood pressure, optimization of cholesterol levels, optimal drugs, good diet, regular exercise are the key components of long term treatment. The exact drugs will depend on the individual and there is no single prescription for all. The dosage will have to be titrated according to the clinical condition.

5. A comfortable temperature will prevent fluid/electrolyte loss by sweating etc. A comfortable environment should be maintained as far as feasible.

Kindly upload the ECG and ECHO findings so that I can give you a more specific answer.

With regards,
Dr RS Varma
Above answer was peer-reviewed by
Follow-up: Sugar level shot up, suffered heart attack. If blockage found, insert stent? Bypass better option? Suggest precaution? 7 hours later
Hi Doctor,

Thanks for your opinion. I have uploaded the scanned copy of recent ECG (Picture 007) done on 1st Feb.

I have also uploaded the images of recent ECHO (Picture 027 and Picture 028).

Waiting for the more clear opinion.

Answered by Dr. Raja Sekhar Varma 1 hour later

Thank you for uploading the images.

The ECG shows an evolved anterior wall myocardial infarction (heart attack). The artery that is usually blocked in such cases is called the Left Anterior Descending Artery (LAD).

Usually there is some permanent damage to the cardiac muscle as a result of such an attack. There is also some reversible damage which can be improved by restoring the blood flow (removing the blocks in the arteries). The exact degree of the damage sustained as also the current pumping efficiency of the heart can be identified by means of an echocardiogram.

What you have uploaded are the images and report of the Ultrasonogram of the Abdomen (not the heart).

If an echo of the heart has not been done, then this should be the first step.

A coronary angiogram is necessary in view of the ECG findings. In view of diabetes, there is a possibility of having blocks in other arteries also. However, only the angiogram can tell us the exact nature of the blocks, the location of the blocks, the number of blocks and the best way of getting rid of them. In any case, she will need lifelong medication to control sugars, improve the functioning of the heart, reduce cholesterol levels, and prevent future heart attacks and strokes. If angioplasty or bypass surgery are planned, they are for further improving the condition by removing the critical blocks in the arteries; they are not a substitute for medicines.

I hope this clarifies your questions.

With regards,
Dr RS Varma
Above answer was peer-reviewed by
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