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Suggest remedies for breathing difficulty after stent placement

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Posted on Fri, 29 Jul 2016
Question: Hi,
My uncle got a stent from a govt.hospital,but after that he had been struggling in getting breath especially during the night.we took him to the same doctor and he gave some medicines and said it happens after the angioplasty,carry on with the medicines.
suddenly during the night he lost his breath and unfortunately got expired,this thing happen in such quick that we couldn't do anything.
I want to know the reason why this happen and how come he was facing breathing problem after the stent surgery.
doctor
Answered by Dr. Shuba Hariprasad (1 hour later)
Brief Answer:
Blood clot or Stent failure

Detailed Answer:
Hello,
Thank you for your query.
I'm Dr. Shuba Hariprasad and will be answering your query today.
I am sorry for your loss.
-did he have chest pain or breathing difficulty before the Stent placement?
-did they say how many blocks and to what degree?
-did they advice bypass surgery at any point of time?
-how long between the procedure and his breathing difficulty? How long gone between procedure and death?
-was he taking blood thinners like aspirin or clopidogrel or warfarin after the angioplasty.

Breathless is a sign of heart failure. Whether it was due to blood clot in the heart or lung or failure of the angioplasty, we cannot say but it shouldn't happen after an angioplasty.
What medications were given to him for this Breathlessness after the procedure?

I hope I've been of help. I can answer you better if you can get back to me with requested clarifications to the above questions.

Wish you good health.
Regards,
Dr. Shuba Hariprasad
Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
doctor
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Follow up: Dr. Shuba Hariprasad (19 hours later)
1-Yes, he had a chest pain but not sure whether he had breathing difficulty before stent operated or not(I was not in XXXXXXX at that time).
2-Dr. said there were two blocks,for 1 they have insert stent and for another stent is not required.as per them blockage was of 90%
3-No,they did not suggest bypass at any level.
4-As per my cousins after surgery,breathing problem had started and doctor suggested to take medicines, they even did not recommend any oxygen cylinder for home,when we told them that breathing problem use to happen only during the night.
5-It was 2 weeks time between surgery and death.
6-Yes, Asprin was advised to him.

I don't remember the test name but something was there which was only 30% but required percentage was 60-70%(I read online at that time) because medicines were not helping him.
doctor
Answered by Dr. Shuba Hariprasad (10 hours later)
Brief Answer:
Major heart attack with edema in lungs

Detailed Answer:
Hello,
Thank you for the follow up.
Here is what I believe happened to your uncle:
- he had blockage of arteries, probably the left coronary artery (which supplies majority of the heart)
- Stent was placed in the one that had 90% blockage.
-the stented artery suffered from inflammation and clotting which was probably not adequately treated with blood thinners and the artery slowly got blocked again.
-night time breathlessness was probably due to fluid collection in his lungs due to the weak heart and poor ejection fraction (30%)
-he suffered a major heart attack the night he died and it was too late to anything

What should have been done:
-repeat angiography to check if the artery was still patent or open.
-check if there was any bleeding or increased clotting tendency by checking clotting parameters in the blood.
-he should have been hospitalized.
-checked if he had bleeding or fluid in his lungs
-an ECG (electrocardiogram) and an echocardiogram should have been performed to check for new attacks or heart muscle weakness or worsened ejection fraction or arrhythmia

Oxygen given at home will not help much in any of these scenarios because it was the heart and the circulation that was failing.
When there is no proper blood flow to carry the oxygen, no point in giving oxygen alone.

That test you mentioned is called the ejection fraction. It is the heart pumping capability.
It normally pumps 60-70 %of the blood that enters it and when it is diseased or suffered an attack, its pumping capacity reduces (30% for you uncle is less than half)
I am again truly sorry for this sudden terrible loss.
I hope I've been of help.
Please let me know if there is anything else I can help you with.

Regards,
Dr. Shuba Hariprasad
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Shuba Hariprasad (12 hours later)
Dr. Shuba,

Thank you so much for your explicit reply,just need to know some more thing.

1-Was there a way get off from this issue with medicines only?
2-Does doctors play smart in such situation and don't tell the truth? they could have told us to get another angioplasty.
3-In this By-pass surgery would have helped?

4-What ever has happened has happened now what is the learning from this? because we still don't know what to do in such situations? whether to trust doctors or do something else?

5-What are the checks we should be doing to avoid heart attack in future?
6-Please also mention the test we should be doing on regular bases.
7-Can we also call you or send the reports to take the another opinion?

Regards
XXXXX
0000
doctor
Answered by Dr. Shuba Hariprasad (9 hours later)
Brief Answer:
Please see below

Detailed Answer:
Hello,

To answer your questions :

1)No medications alone could not have treated this as there was a 90% block. Surgery along with medications is necessary

2) Not all doctors are the same just as no two people are alike. Some may want to cover up their tracks while some may not be willing to admit something went wrong but will still do their best to help the person.
As I don't know exactly what happened, I am unable to comment on your uncle's situation.
Although it shouldn't, extraneous factors like work load, stress, lack of knowledge or resources may lead to errors in judgement.

3)the type of procedure XXXXXXX Ted to restore circulation in the heart depends on the number of blocks, where the blocks are and to what degree.
Both have their positive and negative effects.
I would like to see the angiography report and if possible his electrocardiogram (ecg), blood tests and discharge /death summary to have an idea of his condition before and after surgery.

In any case, the breathing difficulty should have been paid more attention even if it occurred at night. Please tell me what medications they gave for that.

Bypass surgery has an overall better outcome and post surgical prognosis is excellent. During surgery the risk of stroke and sudden death is possible but chances of these occurring are less compared to that of angioplasty.

Angioplasty poses Stent failure and increased inflammation risks and needs to be closely monitored but had the advantages of being less invasive with quicker healing time.


4) in your uncles case, he should have been admitted and assessed for worsening of heart disease or Stent failure. Since his breathing difficulty did not improve with medications, he should have gone back to the hospital for admission.
Insist on admission and making sure all is alright with him symptom wise.
I understand the confusion, anger, helplessness and frustration you all must have endured.

Please note that inspite of being given the best treatment, there would still been a possibility that he may not have survived but at least he would have all the support he needed.
Always get a second opinion when in doubt, at a different hospital if not the same one.

5) and 6)
Heart disease has multiple causes and risk factors. A person may have no bad habits and eat very healthy and exercise regularly but can still have a heart attack.

That said, what you can do minimize chances of this happening are as follows:
- maintain healthy weight. If overweight or obese, lose weight gradually by eating healthy diet and exercising. Do not starve
-quit smoking and alcohol
-try to have some time for relaxation or doing something that calms your mind.
-eat all meals on time and get proper sleep.
-drink plenty of water and limit caffeine to 1cup a day.
-avoid refined grains and processed foods and include whole grains, fresh fruits and veges.
-Limit meat to 2 servings a week. Fish - 3 servings a week.
-exercise for at least half an hour a day before 5pm.do more for weight loss.
-if above 30 yrs of age, have a general check with a family physician and basic blood tests (complete blood count, TSH, free T3, free T4, lipid profile, HbA1C, fasting and post Prandial blood sugar, kidney and liver function tests) ;
Urine analysis, stool routine, chest x-ray and electrocardiogram.

If all normal repeat bloods tests every two years. If above 40, repeat yearly.
Tests will be advised based on individual's current health status, family history, past medical history and other associated medical conditions.

7) I will not be available on phone as I ve an erratic schedule but will be happy to help you out.
I could review blood reports and give my opinion but it is not as good or thorough as personal examination and visit.
You could attach your reports to a query on healthcare magic and address it to me, in which it will allow me to check and answer it or
You could email me at YYYY@YYYY .
Please do so with reference to your name.

Hope I've been helpful. Wish you all well and once again I'm sincerely sorry for your loss.

Regards,
Dr. Shuba Hariprasad


Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
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Answered by
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Dr. Shuba Hariprasad

General & Family Physician

Practicing since :2002

Answered : 1087 Questions

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Suggest remedies for breathing difficulty after stent placement

Brief Answer: Blood clot or Stent failure Detailed Answer: Hello, Thank you for your query. I'm Dr. Shuba Hariprasad and will be answering your query today. I am sorry for your loss. -did he have chest pain or breathing difficulty before the Stent placement? -did they say how many blocks and to what degree? -did they advice bypass surgery at any point of time? -how long between the procedure and his breathing difficulty? How long gone between procedure and death? -was he taking blood thinners like aspirin or clopidogrel or warfarin after the angioplasty. Breathless is a sign of heart failure. Whether it was due to blood clot in the heart or lung or failure of the angioplasty, we cannot say but it shouldn't happen after an angioplasty. What medications were given to him for this Breathlessness after the procedure? I hope I've been of help. I can answer you better if you can get back to me with requested clarifications to the above questions. Wish you good health. Regards, Dr. Shuba Hariprasad