Q: I have had a heart attack recently. I have done both the ECG and Echo. My ECG is abnormal - it read: suspected left hypertrophy probably abnormal ECG and was told by a doctor from a private hospital to do an immediate angiography. The first doctor determined that there is Unstable Angina, Severe LV Dysfunction, Angina Class III, Dyspncca Class III. When, with the second hospital suggesting a second ECHO should be done and would determine the cause of it after few months of medications. Shouldn't I do a MPI (Myocardinal Perfusion Imaging) before doing Angiography because the angiography is a hugely interventional procedure. Or considering the severity of the problem MPI should be considered first? Please suggest which procedure to follow. Also, I am currently taking the following medications: Zabesta 5 mg, Enalpril 2.5 mg, Lasix 40 mg, Altoactone 50 mg, Storvas 20 mg, Clopnigrel-A 75 mg and Nikoran 5 mg. Should I add or delete any other medications?

A:Having gone through the details provided by you, it appears that your heart muscle has become weak because of either a coronary event or you have cardiomyopathy (a primary disorder of heart muscle). Since you do not have significant angina it would be appropriate to have a myocardial perfusion study done first. This would tell us about the viability of the affected muscle and also reversible ischaemia if any. A stress thallium is a very standard method to assess this. If the affected muscle is viable then you need to have delineation of the coronary arteries by angiography. This will tell us about the need for PTCA/Coronary bypass surgery. Coronary angiography is not a hugely invasive study and has an extremely low risk in experienced hands. These days we can also have dfelineation of arteries with a non invasive test (Multislice CT scan).