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Q: myocardial infarction happened on 25.07.2006, details is given under for better understanding of the question?
i had MI on 25.7.05, diagnosed as IW + RVMI, thrombolysed with stk, tmt done +ischemia. coronary angio on 25.10.05 – revealed recanalised RCA with good LV function.pulse 72 regular rhythm BP 130/80 JVP not elevated, no cardiomegaly, S1 S2 normal limits. platelett count was referred as 669.0 k/ul. I have bronchial asthma. cholestrol – 180 mg/dl triglyceride – 184 hdl – 32 ldl-111.2 vldl – 36.8 mg/dl – medicines now taking – aspirin+clopidogrel 75 mg / metoprolol succinate – 25mg / atorvastatin & ezetimibe -5+10 mg. On the above details I would like to know how far i have to take the medicines and what r the precuations for future. I had a irregular smoking habit, quit after 25.07.2005. Now i am having low cholestrol/fat diet and with 90 ml alchohol twice in a month. is alchohol in permissibe limits. what type alchohol is suitable. I have regular sex. I go for walking 30 mins. and play badminton twice a week. No discomfort during the physical activities. no satisfactory ans from doctor

A: I would suggest asking a doctor, but it appears you’ve already done so. To call it safe, I’d stay off the alcohol as much as possible. You have plenty of recreation to stay healthy, but that doesn’t completely prevent a reoccuring issue. As for the medication, that is definitely a doctor issue that I wouldn’t take advice from off this page.

Q: A case of peripheral vascular disease, vascular surgons/ intervention cardiologist please?
One of my patient named Mr. Dhirajbhai Shah 69yrs/ male, he is known case of

Diabetes > 10 yrs

Hypertension > 10 yrs

Ventricular outflow obstruction in brain > 10 yrs

Diabetic nephropathy for last 3 yrs

Benign prostatic hypertrophy for last 6 months

Operated case of CABG and Cholecystectomy,

He developed pain in both legs, pain increases at the time of walking, one limb is swalloen because of filariasis from a long time, his sugar level is under control, s. creatinine is 2.3, no other gross abnormalities in blood reports.

His MR angio of both lowerlimb reveals,

* Narrowing of the distal portion of abdominal aorta

* Non visualisation of right common iliac artery with reformation of right external iliac via collaterals

* Block of proximal and middle thirds of superficial femoral arteries, bilaterally with reconsitution of lower thirds.

* Non visualisation of right anterior and posterior arteries

* non visualisation of middle and distal thirds of left tibial arteries.

Medication : at present he on Oral hypoglycemic agents with sos insulin

Losar H ( Losartan with hydrochlorthiazide 50 + 12.5)

Ecosprin 150 mg ( Aspirin)

Clopidogral 75 mg

Acitrom 2 mg

Atorvastatin 20 mg bed time

Trental 400 mg tds

Symptomatic medicine

As patient is not very much co operative and inspite of chances of renal failure requiring dialysis personally relatives would like to go for non invesive procedure.

Thanking you

Yours sincerly

Dr. Nemish gandhi M.D.
Consultant physician.

Krishna clinic
1/1026 choki street,
Nanpura,
Surat. : 395001
Gujarat
India

m :092279 02941
098252 89330

A: MR angio is famous for not well visualising the lower extremity arteries in detail.

Without seeing the angios, it hard to tell if an endovascular procedure would work. It might be worth it to get a standard angiogram (after proper premedication and hydration). This would provide the interventionalist with badly needed info. If there is significant stenosis in the aorto-iliac vessels, it might be treated with stents.

One possiblity is athrectomy using a device called the Silver Hawk.

However, this isn’t always possible/successful.

A bypass would only work if there are good target vessels below the SFAs.

Difficult situation. Best of luck.

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