Hi ,

Thank you for writing in.

I wish there were more patients like your husband who could earn accolade from their doctors for being dedicated to diet, exercise and drugs!

Let me briefly tell you which you perhaps already know.

The output of heart in later years of life is also contributed by atria (upper chambers of heart) apart from ventricles (lower chambers). As the luck would have it, despite maximum treatment atrial fibrillation persisted thus atrial contribution has been deprived. This is leading to present situation of early fatigue and perhaps decreased threshold for angina.

However, I suggest you check with your cardiologist whether potential thus possible occlusion of the other two grafts has got anything to do with angina.

With such conglomeration of diseases (+ variety of treatments) and equanimity with which your husband had tolerated all these, I would say Bravo, keep it up.

But yes, there are chances that his ventricular rate may increase; he may need additional drugs; he may need a pacemaker or even Automated Implantable Cardioverter Defibrillator (AICD) - probability of which I or any other cardiologist can't predict.

Though, in this situation worrying about potential complication is futile. Let us have faith in Almighty, that he will have no more precipitous troubles which competent cardiologists of Michigan cannot handle.

Hope this helps. Let me know if you need any more information.

Best Wishes.

Dr Anil Grover
Cardiologist

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Hi ,

Thank you for your follow-up query. I will try my best to answer it.

To quantitate the heart function, I am sure your cardiologist must be following some parameters / deterioration of which would correspond to decrease in effort tolerance.

Most common non-invasive method is "Ejection Fraction (EF)" of Left Ventricle. Normal is above 50%. And, in chronic patient like your husband, rate of fall will indicate how rapidly his effort tolerance is going down. That is not its only use. At a particular EF say at <35%, if coronary artery disease is not the immediate cause and there is a specific pattern of EKG, cardiologist may decide in favour of biventricular pacing or implantation of combo device that is Automated XXXXXXX Cardiovertor Defibrillator and biventricular pacing combined. In select group of patients, it increases effort tolerance significantly to make the improve quality of life.

I suggest you discuss these scientific interventions with your cardiologist. It may be so, that your husband is not a suitable candidate for these. Though, there are equal chances that may be he is suitable candidate.

The procedure is done under local anesthesia and the device is implanted below collar bone.

"Everything is not so gloomy. It is too early to give up the fight!"

Hope this helps. If you need more assistance, I will be available to help you out.

Best Wishes

Dr Anil Grover
Cardiologist

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