65yrmale angiography done 4yr back .since than he is on nitrate antiplatlate station antiht.lipid was normal since early.bp 140/90 controlled on anti ht .stress thallium -ve.how long these drugs to be continued except anti ht


This pt has hypertension, CAD, ASYMPTOMATIC ,CTO RCA , negative inducable ischarmia.he needs life style modification life long ANTIPLATELET statin b blocker for mortality benefit. Nitrate can be stopped if angina then u can restart . By guideline as pt is ASYMPTOMATIC thallium negative , pt don't need angioplasty. OPENING CTO RISK WILL BE HIGH .

Treatment should be life long and if thallium is negative for inducible ischemia then there is no benefit of revascularisation CABG or PCI. just keep on medical management till any new sign or symptoms appear.

Dr vijay Gupta sir ABOVE Patient don't need either angioplasty noR CABG, Whether he is DM OR NOT doesn't matter.

i have not read the thallium test but for future specially when if the DM patient will go in to any cardiac event the procedure done now ll help in his ejection fraction.recently a DM patient admitted with 40 EF RCA 90% block had to go for stenting as the area of mycardium cardiologists suggested to salvage around RCA supply as to improve functioning in Global ischemia

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better if he takes for life time,and RCA needs to be stented

would the management be different, if he is diabetic sir?

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In era of evidence based medicine we should follow guideline rather than our person opinion.

Dr anirudha no role of CABG IN SINGLE VESSEL Involing RCA

This pt is completed worked up and require optimal medical management with life style modification only.

life time medication if no symptoms nothing to do

100%block showing what is treatment for it Sir?

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the treatment should be life long.in figure there is 100% block so patient need CABG

medicines r must for life time regular checking and monitoring also must may need surgery b prepared

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