Q: A patient aged 60 yrs is suffering from triple vessel disease with left ventricular dysfunction with 40 percent ejection fraction. Is he fit for by-pass surgery, balloon angioplasty or should he continue to be under medical management only? Kindly suggest any other cost effective remedy which will improve his condition with minimum drugs.

A:In general patients with three vessel disease and low left ventricular ejection fraction (LVEF) need bypass surgery/angioplasty depending on the findings of coronary angiography and the area at risk as defined by the clinical picture coupled with echo or stress thallium findings. It is important to see the angiography film. I am sure the cardiologist treating you must have taken these facts into consideration.