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Had a heart attack. Diabetic. Echocardiogram done. Which is better; Bypass or permanent medication?

I need your advice. My husband had a heart attack some 2 weeks ago, he is 60 years of age and also diabetic type2.
the Echo chowed left ventricular enlargement and severe global dysfunction and hypokinesia of the lower inter-ventricular septum and apex. Normal valves and pericardium
Left atrium was normal and right sides chambers normal.Ejection fraction 35%
He was told to go for an angiogram for which we will have to travel to either South Africa or India
what i want to know, would it be advisable to have a bypass or angiography or would it be better to live on life long medication and what would his life expectancy be?
Asked On : Sat, 20 Apr 2013
Answers:  2 Views:  50
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Internal Medicine Specialist 's  Response
Jan 2013
Thanks for posting your query.
Diabetes is due to progressive loss or destruction of beta cells in endocrinal part of pancreas.
Diabetes is a multi organ disease with involvement of almost all organs of body due to its complications.
Blood sugar both fasting and postprandial must be in controlled range.
In my personal opinion, your husband should go for angiography as heart parameters are already deranged.
If Angiography suggests > 70% occlusion of coronary arteries then only treating doctor decide for angioplasty.
Angioplasty could be done by placing stents or by using lower limbs veins.
Its better to go for stents.
As heart parameter are already disturbed, quality of life is also hampered. Only medication intake may put him at risk of second attack while angioplasty gives him better safety.
Take care,
Dr. Mayank Bhargava
Answered: Sat, 20 Apr 2013
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Internal Medicine Specialist Dr. Akhilesh Dubey's  Response
Welcome to HCM,
Your husband recently suffered Heart attack ( Myocardial infarction),and he is diabetic too.
2 D Echocardiography report is consistent with Ischemic heart disease and there is left ventricular dysfunction with EF 35%.
He is appropriately advised Coronary Angiography to find out extent of coronary artery blockages and result of angiogram will decide about revascularization that is Angioplasty with stent or a surgical one CABG.
You should understand there may be other areas of heart which have compromised blood supply, hence once we restore blood supply to those areas left ventricular function will also improves.
That is logical and treatment of choice,if due to any reason if it is not possible then optimal medical therapy( Aspirin, Beta Blocker,ACE inhibitor,Statin, and diuretics) should continue life long with good diabetic control.
We wish him healthy and long life,
Take care of him
Good Luck
Answered: Sat, 20 Apr 2013
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