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Is Heart Stent Placement Mandatory Despite Taking Medication Regularly?
Posted on
Tue, 22 Nov 2016
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Tue, 22 Nov 2016
Answered on
Mon, 19 Dec 2016
Last reviewed on
Question : Dear Sir,
My father is presently 67 years old and a heart patient.
He first got a heart attack in 2002-03. That time he was admitted to Sector 32, general medical, XXXXXXX hospital while under attack. He was not operated and the hospital discharged him after a few days with some advisories, which was not advised i believe as a mandate to be followed. Though, he kept taking walks and all in the interim period but did not took any medicine.
The attack re-occured and was admitted to Fortis Hospital on 27th December 2007 and was under supervision of XXXXXXX cardiologist Dr. XXXXXXX Jaswal and his team. On 28th December 2007, Angiography was done and it showed triple vessel disease
As per the team of doctors, his heart was not strong enough to take CABG. He was finally discharged on 13th January 2008. As per doctors, his CD was also discussed with the XXXXXXX surgeon (Dr. Trehan). Father, stayed in hospital for around 17-18 days and was discharged on medical management. His discharge summary is attached for your reference.
(Scanned image: Tests medication and discharge summary 2008.pdf)
He has been on under regular check ups with Dr. XXXXXXX Jaswal at fortis since then and all medications during the period are attached for your reference. Almost at every visit the doctor had insisted on going for stunts or Bye pass.
(Scanned image: Medication change from 2009 till date.pdf)
Later, In July 2014, Dad was having some urinatery infection (pus cells) and had gone week because of fever. Fearing, may be heart has something to do with it, he again went to Dr. R.K jaswal for routine visit. He was again recommended an angiography, which we went ahead this time and CAG was done on 04th July 2014. The details of both angiographies on 28th December 2007 & 04th July 2014 are attached for your reference.
The doctor again recommended for stunts stating though it is not the perfect solution for his problem but it shall help. However, father insisted that he shall not be having it right now. Having recovered from urinatory infection in a few days, he has been comfortable and looking healthy.
Further to myself, there appears (to myself as a lay man) an improvement in the CAG report of July 2014 than the one in Dec 2007
(Scanned image: CAG reports Dec 2007 & July 2014.pdf)
Having said above, a few submissions that my Father is:
1. Very particular in taking medicine since his second attack i.e January 2008 (never misses it)
2. Has a very active life style even before his first heart attack. His activity levels can make a lad of my generation to shame. Since retired does house hold work as well. I advise him to go easy though.
3. Keeps busy with his grand kids and friends as well.
However, even after his active life style and his feeling healthy, I wish to understand on precautionary note as under:
1. Your opinion on the above i.e medication, doctor’s counsel etc, since his second attack in December 2007.
2. Kindly advise if we should go for a stunt insertion even after considering he appears to be particularly well on medicines (as explained well about his activity level)
3. There is one supplement available in the market by the name Salmon Omega 3, which is considered to be very beneficial to heart’s health like maintaining lipid profile. The detail of the supplement is as under:
(Salmon Omega -3 contains a unique blend of omega -3 oils sourced from salmon raised in the cold, pure waters of Norway & a proprietary blend of 3 additional omega-3 sources – Anchovy, Mackerel, Sardines from the Atlantic and Pacific oceans.
Each softgel has a balance of 180EPA:120DHA, with a total of 300mg of omega-3 fatty acids in most active form which can be easily used by the body).
As I seriously look forward to buy it and ask my father to take it atleast during winters. I wish to know from yourself :
4. If he can take it along with the present medicines he has been taking for his heart problem. Present medicines in attachment (Scanned image: Medication change from 2009 till date.pdf)\
5. Does Omega-3 has benefits for heart.
A total of 5 queries above.
Regards
XXXX XXXXXXX XXXX
My father is presently 67 years old and a heart patient.
He first got a heart attack in 2002-03. That time he was admitted to Sector 32, general medical, XXXXXXX hospital while under attack. He was not operated and the hospital discharged him after a few days with some advisories, which was not advised i believe as a mandate to be followed. Though, he kept taking walks and all in the interim period but did not took any medicine.
The attack re-occured and was admitted to Fortis Hospital on 27th December 2007 and was under supervision of XXXXXXX cardiologist Dr. XXXXXXX Jaswal and his team. On 28th December 2007, Angiography was done and it showed triple vessel disease
As per the team of doctors, his heart was not strong enough to take CABG. He was finally discharged on 13th January 2008. As per doctors, his CD was also discussed with the XXXXXXX surgeon (Dr. Trehan). Father, stayed in hospital for around 17-18 days and was discharged on medical management. His discharge summary is attached for your reference.
(Scanned image: Tests medication and discharge summary 2008.pdf)
He has been on under regular check ups with Dr. XXXXXXX Jaswal at fortis since then and all medications during the period are attached for your reference. Almost at every visit the doctor had insisted on going for stunts or Bye pass.
(Scanned image: Medication change from 2009 till date.pdf)
Later, In July 2014, Dad was having some urinatery infection (pus cells) and had gone week because of fever. Fearing, may be heart has something to do with it, he again went to Dr. R.K jaswal for routine visit. He was again recommended an angiography, which we went ahead this time and CAG was done on 04th July 2014. The details of both angiographies on 28th December 2007 & 04th July 2014 are attached for your reference.
The doctor again recommended for stunts stating though it is not the perfect solution for his problem but it shall help. However, father insisted that he shall not be having it right now. Having recovered from urinatory infection in a few days, he has been comfortable and looking healthy.
Further to myself, there appears (to myself as a lay man) an improvement in the CAG report of July 2014 than the one in Dec 2007
(Scanned image: CAG reports Dec 2007 & July 2014.pdf)
Having said above, a few submissions that my Father is:
1. Very particular in taking medicine since his second attack i.e January 2008 (never misses it)
2. Has a very active life style even before his first heart attack. His activity levels can make a lad of my generation to shame. Since retired does house hold work as well. I advise him to go easy though.
3. Keeps busy with his grand kids and friends as well.
However, even after his active life style and his feeling healthy, I wish to understand on precautionary note as under:
1. Your opinion on the above i.e medication, doctor’s counsel etc, since his second attack in December 2007.
2. Kindly advise if we should go for a stunt insertion even after considering he appears to be particularly well on medicines (as explained well about his activity level)
3. There is one supplement available in the market by the name Salmon Omega 3, which is considered to be very beneficial to heart’s health like maintaining lipid profile. The detail of the supplement is as under:
(Salmon Omega -3 contains a unique blend of omega -3 oils sourced from salmon raised in the cold, pure waters of Norway & a proprietary blend of 3 additional omega-3 sources – Anchovy, Mackerel, Sardines from the Atlantic and Pacific oceans.
Each softgel has a balance of 180EPA:120DHA, with a total of 300mg of omega-3 fatty acids in most active form which can be easily used by the body).
As I seriously look forward to buy it and ask my father to take it atleast during winters. I wish to know from yourself :
4. If he can take it along with the present medicines he has been taking for his heart problem. Present medicines in attachment (Scanned image: Medication change from 2009 till date.pdf)\
5. Does Omega-3 has benefits for heart.
A total of 5 queries above.
Regards
XXXX XXXXXXX XXXX
Brief Answer:
I would like to explain as follows:
Detailed Answer:
Hello XXXXX!
Welcome on HCM!
I carefully reviewed all your uploaded medical and tests reports and would like to explain as follows:
1) Regarding medications, I would say that your father has been prescribed all the recommended classes of drugs according to the current international guidelines of coronary artery disease, heart failure and diabetes.
All the most important drugs (double anti-aggregation with Aspirin and Clopidogrel; beta-blocker (Metoprolol); ACEI (Ramipril); statins (Atorvastatin); Trimetazidine; diuretics (Torsemide); antidiabetics (Glimepiride); PPIs (Pantoprazole) are prescribed.
The above treatment coupled with the underlying recommendations on the most appropriate life-style, diet and supplements seem to be the proper strategy in addressing your father's health issues.
Unfortunately, in such circumstances the medications have their own limitations; they may slow down the progression of atherosclerotic coronary plaques, but the existing lesions need a more aggressive strategy (coronary revascularization through CABG or percutaneous angioplasty).
2) After reviewing the uploaded coronary angiography reports, I could explain that a diffuse coronary artery disease is present. CABG remains an option, but also percutaneous coronary angioplasty with stents implantation seems to be a rationale approach, at least for the majority and most important coronary stenoses (LAD, OMs of LCX, and probably Lesions in RCA even they seem diffuse).
My personal professional opinion goes in favor of trying first percutaneous stents implantation (PCI).
It could offer a satisfactory beneficial result. Only after PCI failure, CABG would remain unequivocal.
3) The supplement prescribed by your doctor seems to be appropriate for your fathers heart problem. Omega-3 (found in certain see fishes) and Omega-6 fatty acids offer a protective effect against atherosclerosis progress and coronary plaque enlargements. I encourage you to consider starting this or any other similar product.
4) I reviewed the recent medical therapy and would like to explain that there is not any adverse interaction between them when used concomitantly. They seem to be safe and well-tolerated.
5) So, omega-3 fatty acids offer an additive protective effect over your father’s current medical treatment and it would be advisable to seriously consider this alternative.
BUT, don’t forget to first consider one of the above mentioned coronary revascularization alternatives (PCI or CABG).
Hope to have clarified your main uncertainties!
In case of any further questions, do not hesitate to ask me again.
Kind regards,
Dr. Iliri
I would like to explain as follows:
Detailed Answer:
Hello XXXXX!
Welcome on HCM!
I carefully reviewed all your uploaded medical and tests reports and would like to explain as follows:
1) Regarding medications, I would say that your father has been prescribed all the recommended classes of drugs according to the current international guidelines of coronary artery disease, heart failure and diabetes.
All the most important drugs (double anti-aggregation with Aspirin and Clopidogrel; beta-blocker (Metoprolol); ACEI (Ramipril); statins (Atorvastatin); Trimetazidine; diuretics (Torsemide); antidiabetics (Glimepiride); PPIs (Pantoprazole) are prescribed.
The above treatment coupled with the underlying recommendations on the most appropriate life-style, diet and supplements seem to be the proper strategy in addressing your father's health issues.
Unfortunately, in such circumstances the medications have their own limitations; they may slow down the progression of atherosclerotic coronary plaques, but the existing lesions need a more aggressive strategy (coronary revascularization through CABG or percutaneous angioplasty).
2) After reviewing the uploaded coronary angiography reports, I could explain that a diffuse coronary artery disease is present. CABG remains an option, but also percutaneous coronary angioplasty with stents implantation seems to be a rationale approach, at least for the majority and most important coronary stenoses (LAD, OMs of LCX, and probably Lesions in RCA even they seem diffuse).
My personal professional opinion goes in favor of trying first percutaneous stents implantation (PCI).
It could offer a satisfactory beneficial result. Only after PCI failure, CABG would remain unequivocal.
3) The supplement prescribed by your doctor seems to be appropriate for your fathers heart problem. Omega-3 (found in certain see fishes) and Omega-6 fatty acids offer a protective effect against atherosclerosis progress and coronary plaque enlargements. I encourage you to consider starting this or any other similar product.
4) I reviewed the recent medical therapy and would like to explain that there is not any adverse interaction between them when used concomitantly. They seem to be safe and well-tolerated.
5) So, omega-3 fatty acids offer an additive protective effect over your father’s current medical treatment and it would be advisable to seriously consider this alternative.
BUT, don’t forget to first consider one of the above mentioned coronary revascularization alternatives (PCI or CABG).
Hope to have clarified your main uncertainties!
In case of any further questions, do not hesitate to ask me again.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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