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My question to be answered by Dr XXXXXXX Maheshwari.Please this

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Posted on Mon, 1 Apr 2019
Question: My question to be answered by Dr XXXXXXX Maheshwari.Please this is a kind request.
Dear doctor,
I had discussed mu mother's problem to you,
I had uploaded reports.In her engiography. As I understand she has 2 blockages- one about 90% (actually in cd it was 70-80% )and other about 50%.in lefe artery.while one in the right artery 98%.Pl confirm the position with the reports sent earlier.I will try to upload them now.
When we took second opinion of one of the famous cardiologist in XXXXXXX he said 2 ways we can go for-
1. There is no urgency or emergency right now to go for engioplasty or bypass as she does not complain about angina,chest pain,fatigue etc,and her pumping rate is 60%.You can go for the engioplasty of the 98%blockage in right artery.We will not touch left artery .those 90%and 50% will not cause harm.
2.Other way is that we can keep her on medications prescribed in report,for years.If she complains about angina etc then we will go for engioplasty,
1.My question to u is how safe is engioplasty in her case?
2.Can we go to engioplasty.soon for 98% block in right artery?
3.Is prolonging medicines ,following proper diet and exercise can reduce the risk of heart attack??
Pl note that Dr XXXXXXX Maheshwari should answer my question.

Regards,
Ms,Abhyankar



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Follow up: Dr. Sameer Maheshwari (0 minute later)
My question to be answered by Dr XXXXXXX Maheshwari.Please this is a kind request.
Dear doctor,
I had discussed mu mother's problem to you,
I had uploaded reports.In her engiography. As I understand she has 2 blockages- one about 90% (actually in cd it was 70-80% )and other about 50%.in lefe artery.while one in the right artery 98%.Pl confirm the position with the reports sent earlier.I will try to upload them now.
When we took second opinion of one of the famous cardiologist in XXXXXXX he said 2 ways we can go for-
1. There is no urgency or emergency right now to go for engioplasty or bypass as she does not complain about angina,chest pain,fatigue etc,and her pumping rate is 60%.You can go for the engioplasty of the 98%blockage in right artery.We will not touch left artery .those 90%and 50% will not cause harm.
2.Other way is that we can keep her on medications prescribed in report,for years.If she complains about angina etc then we will go for engioplasty,
1.My question to u is how safe is engioplasty in her case?
2.Can we go to engioplasty.soon for 98% block in right artery?
3.Is prolonging medicines ,following proper diet and exercise can reduce the risk of heart attack??
Pl note that Dr XXXXXXX Maheshwari should answer my question.

Regards,
Ms,Abhyankar



doctor
Answered by Dr. Sameer Maheshwari (3 hours later)
Brief Answer:
Please see the detailed answer below

Detailed Answer:
Hi XXXXXXX
Welcome back.

As I remember in your last question, the reports revealed she has the critical disease in all 3 vessels with left main disease and she has chest pain.

As the results in the analysis of CD could be different from that of a printed report and the analysis varies from operator to operator.

I am very happy to hear that the disease is not that critical.
Now coming to your questions one by one.

1) The criticality of a disease depends mainly on symptoms patient is having. Actually, when there is a block in artery some small bypassing branches called as Collateral develop which relieve the patient of pain.

So if the pain is there, then the urgency of opening the vessel is high and if there is no symptom, there is no urgency but the vessel should be opened as the collateral are very small branches and can get blocked anytime.

2) And yes the doctor is very right that she could temporarily be kept on medical management and if she develops symptoms, angioplasty should be done.

But I'll advise that she should go for angioplasty.

3) If done by good and experienced hands, the procedure will be very safe. Her heart pumping is also normal, so despite her age, I hope she will tolerate the procedure well enough.

4) As your doctor saw the CD and said the procedure has no urgency and therefore I guess the blockage is not very tight.

Nobody can predict whether she will have a heart attack despite being on medicines. She will anyhow (being done angioplasty or kept on medical treatment) will need optimized medicine in the form of dual antiplatelet and other cardiac medications.

To conclude, if she has chest heaviness on exertion or exercise go for angioplasty soon. If there is no symptom, you can keep her on medical management for now.

Thank and regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Sameer Maheshwari (0 minute later)
Brief Answer:
Please see the detailed answer below

Detailed Answer:
Hi XXXXXXX
Welcome back.

As I remember in your last question, the reports revealed she has the critical disease in all 3 vessels with left main disease and she has chest pain.

As the results in the analysis of CD could be different from that of a printed report and the analysis varies from operator to operator.

I am very happy to hear that the disease is not that critical.
Now coming to your questions one by one.

1) The criticality of a disease depends mainly on symptoms patient is having. Actually, when there is a block in artery some small bypassing branches called as Collateral develop which relieve the patient of pain.

So if the pain is there, then the urgency of opening the vessel is high and if there is no symptom, there is no urgency but the vessel should be opened as the collateral are very small branches and can get blocked anytime.

2) And yes the doctor is very right that she could temporarily be kept on medical management and if she develops symptoms, angioplasty should be done.

But I'll advise that she should go for angioplasty.

3) If done by good and experienced hands, the procedure will be very safe. Her heart pumping is also normal, so despite her age, I hope she will tolerate the procedure well enough.

4) As your doctor saw the CD and said the procedure has no urgency and therefore I guess the blockage is not very tight.

Nobody can predict whether she will have a heart attack despite being on medicines. She will anyhow (being done angioplasty or kept on medical treatment) will need optimized medicine in the form of dual antiplatelet and other cardiac medications.

To conclude, if she has chest heaviness on exertion or exercise go for angioplasty soon. If there is no symptom, you can keep her on medical management for now.

Thank and regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Sameer Maheshwari (11 hours later)
Thx a lot Dr,for urgent reply,
1.We are in a fix now to decide whether engioplasty to be done immediately or to wait atleast for a month or two.My mom has no symptoms of chest pain,angina or related..and heart pumping rate is also normal,hence feel sometimes that why unnecessary to trouble her?
But on the other hand I feel that the blockage in the right artery is a severe and may cause trouble anytime so without wasting any more time,we should go for engioplasty,very confused and tensed
2.My mother has started Ayurvedic treatment 'Madhavbag'.It has branches all over in XXXXXXX
Those are ayurvedic doctors and give a strict diet plan and provide the diet food packets like flores,soup powders, ask to eat salads very very less oil in the food,no maida,dairy products .Particulat fruits to be eaten like pomgranate.
She is also doing exercises and they give body massage(panchskarma).u can get more info,about this on google,The idea to develop coroneals ,small alternative vessels through which blood suply can be possible
3.Do u know abt these techniques??Do they help in a longer run??
pl suggest the remedyery much confused and worried.
regards,
Alpana
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Follow up: Dr. Sameer Maheshwari (0 minute later)
Thx a lot Dr,for urgent reply,
1.We are in a fix now to decide whether engioplasty to be done immediately or to wait atleast for a month or two.My mom has no symptoms of chest pain,angina or related..and heart pumping rate is also normal,hence feel sometimes that why unnecessary to trouble her?
But on the other hand I feel that the blockage in the right artery is a severe and may cause trouble anytime so without wasting any more time,we should go for engioplasty,very confused and tensed
2.My mother has started Ayurvedic treatment 'Madhavbag'.It has branches all over in XXXXXXX
Those are ayurvedic doctors and give a strict diet plan and provide the diet food packets like flores,soup powders, ask to eat salads very very less oil in the food,no maida,dairy products .Particulat fruits to be eaten like pomgranate.
She is also doing exercises and they give body massage(panchskarma).u can get more info,about this on google,The idea to develop coroneals ,small alternative vessels through which blood suply can be possible
3.Do u know abt these techniques??Do they help in a longer run??
pl suggest the remedyery much confused and worried.
regards,
Alpana
doctor
Answered by Dr. Sameer Maheshwari (14 hours later)
Brief Answer:
Please see detailed answer

Detailed Answer:
Hi,
Welcome back and sorry for replying late.
As the blockage is tight it will need angioplasty now or later. It is very good time that her heart function is normal. The vessel can get blocked anytime which may cause heart attack and decline in heart function.
I can understand that she currently has no symptoms, their might be collaterals working currently but they are very small arteries which themselves can get blocked.
So she should go for Angioplasty.
Their might be chance that she remains fine on medical treatment and Ayurvedic therapy (We ourselves have seen patients with more critical disease remaining fine on medical treatment). But their is always a risk, we never know who will remain fine and who will develop problem.
As the disease is serious and in front of us it should be treated in time.
Coming to Ayurvedic therapy, we don't know much about it so it will be very difficult to comment anything about it.
Yes we know that they help in developing collaterals but I think it is good to do it when the disease is not that serious.
We as a cardiologist do understand going for any invasive procedure is difficult for every one but you really have to deal with it today or tomorrow.
Following a strict diet plan is very important for her and that has to be continued life long, but that won't decrease the pre existing disease and only help in preventing further blockage.

So to conclude, their is always a risk in continuing medical therapy and other form of treatment plans.
I suggest to go for Angioplasty.
Don't worry she will be fine during and post procedure. Every procedure comes with certain risks but that has to be taken when benefits exceed the risks involved.
My best wishes and prayers are with her, she will be fine.

Thanks and regards
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Sameer Maheshwari (0 minute later)
Brief Answer:
Please see detailed answer

Detailed Answer:
Hi,
Welcome back and sorry for replying late.
As the blockage is tight it will need angioplasty now or later. It is very good time that her heart function is normal. The vessel can get blocked anytime which may cause heart attack and decline in heart function.
I can understand that she currently has no symptoms, their might be collaterals working currently but they are very small arteries which themselves can get blocked.
So she should go for Angioplasty.
Their might be chance that she remains fine on medical treatment and Ayurvedic therapy (We ourselves have seen patients with more critical disease remaining fine on medical treatment). But their is always a risk, we never know who will remain fine and who will develop problem.
As the disease is serious and in front of us it should be treated in time.
Coming to Ayurvedic therapy, we don't know much about it so it will be very difficult to comment anything about it.
Yes we know that they help in developing collaterals but I think it is good to do it when the disease is not that serious.
We as a cardiologist do understand going for any invasive procedure is difficult for every one but you really have to deal with it today or tomorrow.
Following a strict diet plan is very important for her and that has to be continued life long, but that won't decrease the pre existing disease and only help in preventing further blockage.

So to conclude, their is always a risk in continuing medical therapy and other form of treatment plans.
I suggest to go for Angioplasty.
Don't worry she will be fine during and post procedure. Every procedure comes with certain risks but that has to be taken when benefits exceed the risks involved.
My best wishes and prayers are with her, she will be fine.

Thanks and regards
Above answer was peer-reviewed by : Dr. Prasad
doctor
default
Follow up: Dr. Sameer Maheshwari (10 hours later)
Doctor,thx for the detailed reply.
1. What are the side effects of engioplasty? do the stent used blocks in future?
2. what precautions particularly diet should be followed by any person,irrespective the age, to remain free from artery blockages?
3. Is this heart disease ,heridatory? Because it is running in my mom's family.All her brothers and sisters have some or the other heart problems.
4. We XXXXXXX going for the engioplasty of 98% blocked artery at right ventricle. We are not going to do for rest of the 2 blockages?
5. Always medically, engiography is followed by engioplasty if doctors suspect anything serious.are there any chances that while performing engioplasty, on the spot, doctor would tell us that bypass is needed right now.can it happen?
6.My mother had a swelling and bruise on her right hand where IV and staining was done. It was ceased after a week. her hand was paining for a week. What was the reason? What are remedies for the same\
Regards,
Alpana
default
Follow up: Dr. Sameer Maheshwari (0 minute later)
Doctor,thx for the detailed reply.
1. What are the side effects of engioplasty? do the stent used blocks in future?
2. what precautions particularly diet should be followed by any person,irrespective the age, to remain free from artery blockages?
3. Is this heart disease ,heridatory? Because it is running in my mom's family.All her brothers and sisters have some or the other heart problems.
4. We XXXXXXX going for the engioplasty of 98% blocked artery at right ventricle. We are not going to do for rest of the 2 blockages?
5. Always medically, engiography is followed by engioplasty if doctors suspect anything serious.are there any chances that while performing engioplasty, on the spot, doctor would tell us that bypass is needed right now.can it happen?
6.My mother had a swelling and bruise on her right hand where IV and staining was done. It was ceased after a week. her hand was paining for a week. What was the reason? What are remedies for the same\
Regards,
Alpana
doctor
Answered by Dr. Sameer Maheshwari (23 hours later)
Brief Answer:
Detailed answer ahead

Detailed Answer:
Hi XXXXXXX
I'll answer your questions one by one.

1) Their is no side effects of angioplasty but one has to take blood thinner which can cause bleeding.
Yes the stent can develop blockage, but it won't if proper precautions, diet and lifestyle measure are taken.

2) Diet in a patient with blockage in coronary arteries irrespective of whether you have a stent should include low fat diet, avoid junk food and do regular exercise (as per patient capacity and age)

3) Yes their is a hereditary association with coronary artery disease too. But that association is important if immediate family members develop heart attack before 60yrs age.
But only hereditary and genetics is not solely associated, their should be other risk factors present to develop a disease.

4) Yes the Angioplasty of the tight blockage of RCA(Right sided artery) should be done. And if later she has chest pain, she may need Angioplasty of the other vessel too.

5) Angiography is followed by angioplasty when their is significant disease visible.
The chance of telling you that she needs bypass during Angioplasty is very rare. It happens only when the arteries are unable to be opened during Angioplasty even after trying for very long. But that also won't be a urgency, the doctor will only tell you that the arteries can not be opened by Angioplasty and she should go for bypass.

6) Bruises post IV cannulation is common especially in a patient on double antiplatelets (blood thinner). That will go away itself. If the swelling and pain is much we generally ask our patients to apply a combination of SUMAC+ Thromphob ointment over the area.

I hope she remains fine during and post procedure and may she have a long and healthy life.
I wish a good luck for the procedure. Just don't panic, be calm.
I'll be happy to help you whenever you need.
You can also send the reports post Angioplasty on my email YYYY@YYYY .

Thanks and regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Sameer Maheshwari (0 minute later)
Brief Answer:
Detailed answer ahead

Detailed Answer:
Hi XXXXXXX
I'll answer your questions one by one.

1) Their is no side effects of angioplasty but one has to take blood thinner which can cause bleeding.
Yes the stent can develop blockage, but it won't if proper precautions, diet and lifestyle measure are taken.

2) Diet in a patient with blockage in coronary arteries irrespective of whether you have a stent should include low fat diet, avoid junk food and do regular exercise (as per patient capacity and age)

3) Yes their is a hereditary association with coronary artery disease too. But that association is important if immediate family members develop heart attack before 60yrs age.
But only hereditary and genetics is not solely associated, their should be other risk factors present to develop a disease.

4) Yes the Angioplasty of the tight blockage of RCA(Right sided artery) should be done. And if later she has chest pain, she may need Angioplasty of the other vessel too.

5) Angiography is followed by angioplasty when their is significant disease visible.
The chance of telling you that she needs bypass during Angioplasty is very rare. It happens only when the arteries are unable to be opened during Angioplasty even after trying for very long. But that also won't be a urgency, the doctor will only tell you that the arteries can not be opened by Angioplasty and she should go for bypass.

6) Bruises post IV cannulation is common especially in a patient on double antiplatelets (blood thinner). That will go away itself. If the swelling and pain is much we generally ask our patients to apply a combination of SUMAC+ Thromphob ointment over the area.

I hope she remains fine during and post procedure and may she have a long and healthy life.
I wish a good luck for the procedure. Just don't panic, be calm.
I'll be happy to help you whenever you need.
You can also send the reports post Angioplasty on my email YYYY@YYYY .

Thanks and regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Dr. Sameer Maheshwari

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Practicing since :2010

Answered : 816 Questions

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My question to be answered by Dr XXXXXXX Maheshwari.Please this

My question to be answered by Dr XXXXXXX Maheshwari.Please this is a kind request. Dear doctor, I had discussed mu mother's problem to you, I had uploaded reports.In her engiography. As I understand she has 2 blockages- one about 90% (actually in cd it was 70-80% )and other about 50%.in lefe artery.while one in the right artery 98%.Pl confirm the position with the reports sent earlier.I will try to upload them now. When we took second opinion of one of the famous cardiologist in XXXXXXX he said 2 ways we can go for- 1. There is no urgency or emergency right now to go for engioplasty or bypass as she does not complain about angina,chest pain,fatigue etc,and her pumping rate is 60%.You can go for the engioplasty of the 98%blockage in right artery.We will not touch left artery .those 90%and 50% will not cause harm. 2.Other way is that we can keep her on medications prescribed in report,for years.If she complains about angina etc then we will go for engioplasty, 1.My question to u is how safe is engioplasty in her case? 2.Can we go to engioplasty.soon for 98% block in right artery? 3.Is prolonging medicines ,following proper diet and exercise can reduce the risk of heart attack?? Pl note that Dr XXXXXXX Maheshwari should answer my question. Regards, Ms,Abhyankar