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Is it necessary for my father to undergo angioplasty?

Q: My father is 57 years old. He weighs 75 kg and has high BP and uric acid problems. He had back pain 3 weeks back. It slowly moved to the arm and then to the chest. After the ECG test, the doctor said that he had a minor heart attack and admitted him to the hospital. His pain remained for around 10-12 hours. The doctor also did a nicotine test, which first came out negative and then positive. After the first aid, he was discharged but recommended to undergo angiography. We are from a middle class family and have no medical background. Health sector has commercialised now, and I wanted an honest advice for following. Are there any non-invasive tests, for my father before he goes for angiography? Where can they be taken? TMT is not advisable for my father, as per the consultant. After angiography, if the doctor finds there is a blockage then angioplasty is required. How will I come to know that there is really a blockage? Can't it be cured without angioplasty? I consulted a few doctors and everybody said that my father had a minor attack after seeing the ECG. All of them recommended angiography. I feel helpless at this stage. Please advise.

A:I can appreciate your dilemma regarding commercialisation of medicine, but then I can assure you that majority of doctors are sincere and honest, though I can not deny the existence of an occasional outcast in our society. As for your specific queries: 1. One can do a Treadmill Test/Stress Echocardiography/Radionuclide Study/Electron Beam CT to get some idea about presence or absence of blockages but they are not fool proof and can miss blockages. TMT is accurate to the extent of 85%, Stress Dobutamine Echo and Radionuclide Scan 92-94% and Electron Beam CT also in the same range. Therefore, to get a foolproof answer, one has to undergo coronary angiography, especially if one has had a minor heart attack, in which case, presence of blockage is very high. 2. Unless it’s a very minor blockage, which can be reversed with life style modification, most critically blockages cannot be reversed and they have to be reopened either with an angioplasty or a bypass surgery. I don’t think, you can take an educated decision in this matter and you will have to rely on your treating doctor and if you have any reservations about his credentials, you may seek a second opinion. 3. One can certainly start from the scratch but ultimately, as explained earlier, one has to go for coronary angiography to be certain about presence or absence of blockages and therefore, work up from scratch may be a waste of money and effort, as well as time, as even if the other tests are negative and if your father had a minor heart attack, angiography becomes mandatory. I therefore, feel that angiography is certainly justified. I wish you and your father a very happy and long healthy association.

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