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Suggest Treatment For Diastolic Dysfunction

Posted on Tue, 26 Apr 2016

Question: I am 80 years male. My medical history. Had MI in 1987. Stress echo in 2004 & 2009 negative, plaque in (L) carotd, EF N 45% 2006 Stress thalium 2004 - MI - Inf wall with residual inbernation. Br asthma - use SERFLO 250 inhaler two puffs twice a day. Also on Dilzem (twice daily) and ASA. Tests done 7 days ago : Results: Echo- scarred post, inf, basal & mid clat (?) wall & basal IVS Gr I. Diastolic dysfunction. Global LVEF 40 %. Mitral annular calcification present. Mild MR. Trace TR RVSP(?) 32 mg (?). No i/c clot or mars(?),No pericardial pathology. CD: B/L(N) carotid & vertebral(?) arteries essentially (minor calcified plaque bilaterally. no stenosis,
MY QUESTION: Shoud I go for thalium test or coronary angio or CR Angio ? I would like to consult a cardiologist please

In my profile there was a typo error. CR Angio should read CT Angio. I took sorbitrate on three occasions about 10 days ago. This was followed by a bad cold with all the usual symptons, running nose, phlegm, cough ,temperature (99.5) sore throat and wheezing.Was put on medication for 7 days by my physician - Advised Doxcef and ICZ and have now recovered 90%. Have not felt the need for sorbitrate in past 10 days.

Answered by Dr. Anantharamakrishnan (1 hour later)

Brief Answer:
Coronary Angio is ideal

Detailed Answer:
Hi friend
Welcome to Health Care Magic

     The IDEAL option is to undergo catheterisation and coronary angiography with a view for possible intervention. It is the only way to directly ‘see’ the block, if any – and its location, extent, severity and so on. Coronary arteriography is invasive but it is the gold standard for this… especially with your past history and recent nitrate use

     The ALTERNATIVE will be to go for TMT (Treadmill Exercise ECG) with thallium isotope – it is the ideal non-invasive way to evaluate ischemia / to assess the PHYSIOLOGY (function) – to see whether the blood arriving at the heart muscle.
     If there is XXXXXXX suggestion, the next step is to see the ANATOMY (structure) – CT angio is non-invasive study for the anatomy. If positive, she will need catheterisation, anyway.

Good luck
God bless you

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (2 hours later)

Thank you Dr. Anantharamakrishnan, I am keen to go initially for a non-invasive investigation. Does a Thalium test show the extent of blockage(s) after which the surgeon can decide on any further intervention ? Or go for a CT Angio initially and then decide on further action ? Also as I am in New XXXXXXX where would you suggest is the best hospital to go for and the best surgeon bearing in mind my age and past medical history ? Many thanks.

Answered by Dr. Anantharamakrishnan (10 minutes later)

Brief Answer:
Good enough

Detailed Answer:
Hi

Thallium test does not show the blockage – only the effect of the blockage
The Physician - not surgeon - is the one / any clue, he will insist on the next step - CT

CT angio will show the extent and severity of blockage

There are several reputed hospitals in XXXXXXX XXXXXXX Escorts, Apollo, Fortis etc - all are good

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (53 minutes later)

Is there a risk in a CT Angio ?

Answered by Dr. Anantharamakrishnan (5 hours later)

Brief Answer:
Negligible

Detailed Answer:
Practically nothing / Radiation exposure (minimal nowadays) and contrast side effects (allergy in some; kidney damage if he amount in excess) – are possibilities

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar