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heaviness of chest

Q: 1) A pt of age 62 yrs had complaint of heaviness of chest with profuse sweating and was diagnosed as a case of anterior wall MI + right ventricle MI + posterior wall MI and was thrombolysed with urokinase. Patient was in complete heart block and was taken for TPI. He had recurrent episodes of Ventricular tachycardia and was reverted back to Normal Sinus Rhythm. Later patient was taken for CAG, which revealed Two vessel disease with good left ventricular function. Pt. is a known case of NIDDM on insulin + controlled High BP with Enalapril (5mg OD) + a smoker. How much percentage is CABG indicated and what are the complications of this procedure?

A:You seem to have a large area at risk and thrombolysis seems to have been life saving for the patient in view of a good Left ventricular function. There is no doubt that the patient needs coronary revascularisation at an early date. The procedure could be PTCA with stents or CABG depending on the kind of blocks, the length of diseased segment and the diameter of the vessels. In general diabetics do better with CABG as compared to stents but with the availablity of drugs like abciximab and drug eluting stents, scene is changing. The decision should be left to the treating cardiologist who would take all the facts into consideration.

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