Ask the Doc
Dr. V. V. Bashi, Consultant Cardiologist and Cardiac Surgeon, MIOT Hospitals Chennai answers this week's queries:
MY father is 72. He has moderate to severe pain in his chest and abdomen. After a CT scan, it was diagnosed as "Thoracic aorta aneurysm". In Mediastinum part, it described that dialation of arch aorta extending down up to abdomen measuring 6.8x7.2cm. Is surgery necessary? R. Natarajan
Answer: It looks like your father is suffering from aneurysm of the thoracic aorta, which means there is a balloon-like dilatation of the aorta that takes blood from the heart to the rest of the body. This condition needs early medical attention. When the dimension of the aneurysm is more than six cm, it has to be treated by surgery or endovascular grafting. During surgery an artificial tube is used to replace the aorta's diseased part. In endovascular grafting, a graft is introduced without major open surgery. Medical treatment carries the risk of sudden rupture of the aneurysm, which may be fatal. You should contact a surgical team experienced in doing aneurysm surgery and endovascular grafting at the earliest.
I underwent CABG surgery for triple vessel blocks in 2001. I walk daily and am on a fat-free diet. I take lipid profile test once in every three months. During the last one-and-half years, my HDL has been consistently low — between 25 and 35 despite taking Atorvastatin calcium tablet (one daily). What should I do to increase my HDL? How long will the graft last? Name withheld
Answer: HDL usually increases with regular exercise. In general, HDL level is low in Indians, which is one of the reasons for increased incidence of coronary artery disease in our country. If the by-pass was done with arterial grafts (internal mammary artery) it does not get blocked for 15-20 years in 90 per cent of patients. Life span after surgery depends upon the patient's condition at that time. If the heart muscle was not damaged and if the arteries did not have multiple blocks then you will have a relatively normal life span. If the heart muscle was damaged with multiple heart attacks, resulting in reduced pumping capacity, one can develop heart failure over time. In such patients, by-pass surgery increases the quantity of life compared to medical treatment. By-pass surgery generally increases the quality and quantity of life with the advantage of taking less medication. In patients with diabetes they can do normal exercise after the operation, which helps them have a proper control of diabetes, which indirectly increases their quality and quantity of life.
After an angioplasty in early September owing to a block in one of the arteries, I was advised to take pletox-100(Cilostazol Tablet) plus ecosprin 150mg(twice a day)along with other medicines. What is the function of Pletox and Ecosprin? Also I think I have developed acidity since I have difficulty in breathing and feel uneasy. Are there any tests to show if my heart is healthy or not? Lily Joseph
Answer: The medicines prescribed to you are basically blood thinning tablets given after angioplasty to prevent blockage of the stent with blood clots. The acidity may be due to the intake of Ecosprin. Your uneasiness and breathlessness could be due to a problem in the heart. If you have repeated symptoms, contact the cardiologist who did your angioplasty. Tests like TMT and Echocardiogram may give some information regarding your condition. You may have to undergo another coronary angiogram to rule out further blocks in consultation with your cardiologist.
I am 74. On June 26, 2002, I underwent aortic valve replacement. I was advised the PT test once in 15 days and subsequently once in a month to maintain INR 2.5-3.00. Dosage of Asitrom was increased or decreased depending on the results. On April 26, 2005, INR was 2.98 and on June 14 it was 2.03. The test was repeated on June 25 but the INR value was not given. Again the test was repeated on June 27 and the INR was 1.24. After June 27, I underwent PT tests as below: July 4, 2005 - INR 3.17 (time 39 seconds) July 7. 2005 - INR 2.07 (time 26 seconds) July 23, 2005 - INR 2.5 (time 27 seconds) During this period my BP varied from 160/90 to 150/86. What are the reasons for this variation? All the results are from the same laboratory. K.S. Raghavan
Answer: Variation in the Prothrombin time is a usual problem, which patients face when they take oral anticoagulants like Acitrom. But, one has to take this medicine to prevent blood clotting in the artificial valve. Anticoagulants has to be taken at a regular time everyday. The Prothrombin time test has to be done in the morning. Variation in the time of taking the medicine and timing of the test may sometimes give a false value. Even when you take medicines at a regular time and do the test in the regular fashion the INR value can give variations. It is a problem which everybody faces. Consult your doctor and he will be able to advise you in taking the correct dose of medicines. Intake of leafy vegetables and diets rich in Vitamin-K can produce variation in INR. If the INR value goes above 3.5 you will have to reduce the dosage of Acitrom. Excess medication can produce bleeding from the gum when you brush your teeth and bleeding from other places. If the INR becomes less than 2 then you have to increase the dosage of Acitrom after consulting your doctor. There is no clear cut explanation for the variation in the INR.
Printer friendly
page
Send this article to Friends by
E-Mail
Magazine
