Hello doctor, I ended up with emergency angioplasty after two and a half hour of cardiac pain. The doctor found totally occluded LAD, opened it to 50 percent with angioplasty. He recommends bypass surgery and am waiting to see cardiac surgeon. I am concerned with diagnosis which were almost non-existant. I was discharged from hospital with the following medicines: Before breakfast: Omeprazole, Antacid. After breakfast: Losartan, Angio ll, Aspent, Aspirin, Spironolactone, Diuretic, Ismo, Vasodilator. After dinner: Losartan, Angio ll, Ismo, Vasodilator. 8 PM: Flomax, Tamsulosin, Sennakot. Before bed: Semvistatin 140 mg, Statin, Lorazepam, Relaxant. I am concerned that he did not include a Beta-blocker and a Calcium Channel Blocker. I have variant angina which is quite severe at times. I also am not sure as to the ability of my heart to function and whether I am in danger of pulmonary edema or having liquids around the heart. I will not be able to have surgery for another 2 to 4 weeks and am wondering of my prognosis until then and is it possible to exercise like riding a bicycle at this time. I have included copies of angiogram and echogram for your study and comment.
Hi. The diagnosis of variant angina and STEMI due to total occlusion of a vessel do not go hand in hand normally. The documents provided by you also do not mention that you have variant angina (attachment removed to protect patient identity). Please provide more clarifications that how you concluded you have variant angina. If you really have variant angina, you can still be given Calcium channel blockers. Tablet Ismo also deals with variant angina very well. If you do not have variant angina, Beta-blockers may also be prescribed, provided there are no contraindications like heart failure, etc. Your problem may be managed by bypass surgery or angioplasty to both the vessels provided you are not a diabetic. If your RCA can still be opened by angioplasty is the issue to be decided by interventional cardiologist. In view of recent STEMI and EF of 35 %, you should not ride a bicycle or do strenuous exercise. Pulmonary edema, recurrent angina and heart attack are all possibilities for which you are being treated. Do not worry much. Keep yourself relaxed. You must seek a second opinion from an interventional cardiologist. Discuss risk and benefits both of angioplasty and bypass surgery.