Brief Answer:
see details.

Detailed Answer:
Respected Sir
1. It is not clear from your query that what was ECHO report. If you can upload the report or write down final comments?
2. Coronary artery disease (CAD) or anginal heart disease or the disease causing heart attacks can occur in any individual. The risk factors like diabetes, high blood pressure, smoking, stress, obesity, high cholesterol etc. only increase the risk for heart attacks. Their absence do not give 100% immunity against heart attacks neither their good control by medicines. Diabetic patients are more prone to silent heart attacks.
3. I do not agree with SOS therapy with ESAM. You must consult your cardiologist regarding this and should have a stable therapy for blood pressure control. If she has already sustained a heart attack then she must receive an anti-platelet drug in addition to above drugs. You can get a prescription of same from your doctor.
4. For prevention of future heart attacks she requires a good control of diabetes and high blood pressure. She should avoid all kind of passive smoking. She must take her drugs regularly. She should also remain stress free as far as possible. Avoid fried foods and fats. Maintain an ideal weight (Body mass index ~23). She should also undertake daily exercise as per doctor's prescription. These measures will help her in avoiding a future cardiac event. However there is no test / no treatment which can guarantee that a person will not have heart attack in future.
Hope this helps.
Feel free to discuss further if required.
Sincerely
Sukhvinder

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Brief Answer:
Yes, She had heart attack as per report.

Detailed Answer:
Respected Sir
1. Yes, the report says she had a heart attack (large antero-septal infarction).
2. She should receive an anti-platelet as I suggested before.
3. You should consult a cardiologist for assessment of risk of future events, regarding ESAM and about anti-platelet therapy too. All the precautions mentioned above hold good.
Hope this helps.
Feel free to write if there is anything else.
Sincerely
Sukhvinder XXXXXXX

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Brief Answer:
Please see details.

Detailed Answer:
Respected Sir
The decision of angiogram is not only a technical one, it involves social issues also. It is best taken by the physician looking after the patient and the family, after due consultations. However, a large RWMA (regional wall motion abnormality)on ECHO with dilated left ventricle (with a heart attack which went unrecognised) is a valid reason for angiogram. There are many other reasons for doing an angiogram which can be assessed clinically.
Hope this helps.
Sincerely
Sukhvinder

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Brief Answer:
please see details.

Detailed Answer:
Dear Sir
1. An angiogram should be done only with an intent to perform a revascularization procedure (either angioplasty or bypass surgery). since these are big procedures especially bypass surgery which involve a lot of money and a bit of risk (with bypass surgery), consent of family, motivation of patient & family, everything matters.
For example if a patient is bed-ridden but comes out with an abnormal ECHO, I would not like to proceed for angiogram in such a case. It will probably not help that patient much. Because despite the procedure she will remain in bed and will not get any material benefit.
This aspect will be discussed by your cardiologist in more details.
2. A bad ECHO report is not the only reason for doing angiogram. Patient's symptoms, her complaints, her quality of life, her exercise capacity in relation her daily schedule, her examination findings, her ECG findings, other tests , they all give us a possible picture of her heart and depending upon this picture, we decide to go for angiogram.
3. Regarding the decision of your doctor for angiogram, I elaborated in last answer, that it is one of the valid treatment options in given scenario.
Hope this helps.
Sincerely

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