Brief Answer:
Please see details below.

Detailed Answer:
Dear Sir/ Madam
1. The first step to improve ejection fraction has already been taken i.e. the angioplasty has been done. Once the blood supply to ischemic (deficient in blood supply) myocardium improves, its function will also improve (the part which was not already dead, also called the hibernating myocardium), hence the ejection fraction will improve. Fraction of myocardial pumping (ejection fraction) which is lost because of death of muscle, never recovers.
2. Carvedilol is the foremost drug which will improve ejection fraction, although it will take longer time. It starts showing improvement at about 3 months and will continue to do so till 3 years.
3. Ramipril will improve ejection fraction by reducing the workload against which heart has to pump.
4. Beside, he should take all his drugs religiously. He must not smoke. He should remain free from psycho-social stress. He must undertake physical exercise as prescribed by his cardiologist. Encourage him to meditate. He must rest after all his meals. He should take salt in limited quantity as per the advice of cardiologist. Avoid table salt/ pickles/ chutneys/ papads/ soups. All these will help in avoiding a future acute coronary syndrome and will avoid any excess load on his heart.
5. Do not stop clopidogrel and ecosprin even for a day without consulting your cardiologist.
Hope this provides some help. Feel free to discuss further.
Sincerely
Sukhvinder XXXXXXX

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Brief Answer:
yes , risk to life is there but......

Detailed Answer:
Respected Sir/ Madam
1. There are two main complications associated with stents.
A. Stent thrombosis- The incidence of this complication is very low (~5 episodes in 1000 stents in 1 year) and are best prevented by clopidogrel and ecosprin therapy for at least 1 year.
B. In-stent restenosis- This occurs at about 6-9 months of stent insertion and has incidence of <5%. Some drug eluting stents have remarkably low incidence of restenosis.
If these two complications do not occur in first couple of years, then normally no complication is expected at site of stent insertion. However fresh diseases may appear at other sites.
2. The exercise prescription will be best given by his treating cardiologist. We normally start with a round within the premises of house and then gradually build-up.
3. Yes, low ejection fraction is definitely associated with risk to life. However, in a single patient no prediction can be made. We can only provide best guidelines based treatment.
Hope this provide some insight into the issue.
Feel free to write for further clarifications.
Sincerely
Sukhvinder XXXXXXX

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Brief Answer:
Do not panic.

Detailed Answer:
Dear Ma'm/ Sir
Carvedilol can be given minimum after 12 hours only. So maintain at least 12 hour difference between 2 doses. Nothing alarming.
Sincerely
Sukhvinder Singh

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Brief Answer:
See details below.

Detailed Answer:
Dear Sir/ Ma'm
Yes, An ICD is now a days being advised to patients of coronary artery disease for primary prevention (before any episode of XXXXXXX rhythm disorder of heart). However this requires certain conditions to be met. They include at least 40 days period should have elapsed after heart attack, EF should be less than 35% , Functional status should be class II or III and life expectancy should be more than 1 year.Currently it is not being implanted at time of revascularization procedure (stenting or CABG). Your cardiologist will assess the effect of stenting on PTCA after sometime and assess the need for ICD if EF continues to be less than 35%.
Hope this clarifies the issue.
Sincerely
Sukhvinder

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