Q: My 62 years father weighs 100 kg and is 5.11 inch tall. He had myocardial infarction and has been diagnosed with triple vessel disease. His right coronary artery (RCA) has two blocks. He has gone for angioplasty to treat the first block. The second block in proximal RCA is 50%. My father is a diabetic and smokes as well. What is the prognosis of my father’s condition and how can it be managed?

A:Your father has multiple uncorrected risk factors such a diabetes, dyslipidemia, and smoking, in addition to being obese. In view of the fact that your father already has compromised left ventricular function, and is currently symptomatic, probably consequent to his myocardial infarction, and has triple vessel disease, he would be best off with surgery as the first option. Angioplasty to the remaining vessels is the next best option if possible, using drug-eluting stents. His prognosis with only medical management is poor. In any case, strict control of risk factors is mandatory as well as optimum medical therapy, regardless of which mode of definitive therapy is chosen.