I have the results of a recent angiography and I would like the prognosis explained please.Overall dominance :rightLVA: EF 35%Diagnosis: Moderate LV function,EF 35% with inferior basal akinetic segment.LAD: Diffuse 60-70% disease mid vessel. diffuse 50-60% disease proximal large diagonalCircumflex: occludedRight coronary: proximal flush occlusionNo Angina Thank you for your help
Person's Gender: Male
Person's Age: 80
Hello and Welcome to JustanswerThank you very much for your questionDo you have history of diabetes?You mentioned no angina but is there any shortness of breath specially on exertion?May I please know what do you exactly mean by prognosis?
There is a history of diabetes but it is not medicated, only treated with diet.
There is some shortness of breath on exertion, artritis contributes to limited mobility and there is reduced circulation resulting in feeling cold a lot of the time.
I would like to understand how serious these results are and if there are any preventative measures that would help. This person is a family friend and I would like to support by offering knowledgeable guidance.
Thank you for the detailsSome area to cover here. I will discuss them one by oneThere is evidence of likely past heart attack in inferior region (akinetic or dead area)Diffuse disease is almost highly suggestive of diabetes the reason I asked thisHis heart function is down but we do not expect only inferior akinesia to drop function to this extent so my strong suspicion is that he is still having ischemia or angina in other regions specially in LAD territoryShortness of breath in diabetics is ANGINA EQUIVALENT and we treat it as angina until proven otherwiseFrom practical standpointHe needs to be on treatment for diabetes. Tight control would stop progression. Diet alone may not be sufficient hereHe needs to be on aggressive anti anginal therapy including aspirin, beta blockers, nitrates and ACE inhibitorsHe needs to have his lipids/cholesterol controlled like LDL around 70 or less would be ideal. So Statin treatment is definitely warrantedTo solve EF issue i would suggest to have discussion about non-invasive testing like nuclear perfusion imaging or dobutamine stress testing to see if there is any viable myocardium.....one which is temporarily non functional due to angina or reduced blood supply but can be made functional with restoration of blood supply with either stenting or bypass surgeryHistorically Bypass is recommended in his scenario if testing shows viable myocardium but these days with better drug eluting stents and better therapy stenting is showing almost similar promising results so either of strategy would doPlease let me know if further details are neededBest Regards