Patient present with shortness of breath with chest heaviness while bed but relieve by sitting. CAG report shows triple vessles disease in RCA N LCX AND LAD MID PART WITH LVEF 39%. Patient already taking met xl 50 / deplat a 75/ angispan tr 6.5 bd / nikoran 5 bd / tonact 10 od. Patient is poor so not willing for CABG. Suggest medical mangament

7 Likes

LikeAnswersShare

patient cant be managed with costly medication as he is non affording. we have to send cardiac markers also in this case as we cant ignore chances of a fresh infarct also.. start inj LMWX 0.6 ml s/c bd n overlap it with tAblet warf 5mg from third day. atorvas dose need to be made 80 mg hs aspirin n clopidogrel combination need to b started loop diuretics need to b started for PND symptoms.. Tab Lasilactone(20/50) 1 bd tab Ramipril 5 mg 1 bd for remodelling and slowly taper n omit Ccb start TAb digoxin o.25 mg 1/2 od everyday for the patient for better contractility.

patient is having orthopnoea, S/O cardiac failure. with TVD. for SOB treat with diuretics, can add ACE inhibitor , dual antiplatelet, statins. continue nitrates for angina. but the only solution is CABG. the symptoms will go on increasing with time. so go for surgery. and for affordability , there r so many govt schemes which offer free surgeries. just refer to such centre.

PT HAS ISCHAEMIC DILATED CARDIOMYOPATHY CHF GR IV ORTHOPNOPIA PL CONTINUE ALL ADD = FLUID RESTN .. SALT RESTN SACUBITRIL + VALSARTAN50 BD . DAPAGLIFLOGIN 5 MG METOGARD 35 BD PC

stop met xl start carvedilol 3.125 bd torsemide 10mg od digoxin 0.25 od aspirin 150 od tonact 40mg hs ct nikoran

add ramipril 1.25 bd
0

meant EECP therapy upon failure of maximum medical therapy and since pt not willing for cabg this will help collateral formation and create natural bypass how far it's effective we have to keep fingers crossed but if no way can try it

the basic thing is patient is not willing 4 CABG...and actually that is the answer .. for medical management he sd b on ace in diuretics and..digoxin 4 rest of his life... need of follow up to monitor ccf

PL ADD ORTHOPNOEA

pls start CARVEDILOL+RAMIPRIL+FRUSEMIDE/TORSEMIDE. Stop METOPROLOL.

even after adjusting the cardiac drugs to the maximum then ECCP can also be tried

add ranolazine after stabilisation

Load more answers

Diseases Related to Discussion