Further treatment after a major heart attack

My father is 68 years old and suffered a Major heart attacked in Nov '14. Only thrombolysis was done  at that point and no angiography was done.(It took him 6 hrs to reach the hospital from where the attack occurred).As a results the doctors say that his hear is pumping at 25% instead of normal 65% and LAD is the effected area with considerable heart muscle dead. The same doctors did a TMT (stress test ) on him 45 days after the heart attack and the same came negative and therefore the doctors have advised only medicines to manage the heart disease further. This is at a state run hospital. We have consulted a few cardiologist/cardio surgeons with private practice and they recommend an angiography during which stenting might be done is required and if the blockades are more a bypass may be recommended. The 2 contrary views as well as the rampant misuse of Stents has made us wary of the advice we are getting. What should we do?  

There is no straight answer. Optimal treatment depends on whether there is viable heart muscle in the infarct area or whether there is only a residual scar that will not benefit from improving the blood supply. If the first is true, bypass surgery(CABG) has much better results than stenting in preventing further damage and improving heart function. I answered this question in detail here and expect #1 is the case in your father's case and CABG the best option. CABG maintains and often improves the heart function, so that the “motor” can go back to doing its duty, which is to pump blood to the rest of the body.

Hope this helps,

Dr T


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