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Suggest Treatment For Multiple Gall Bladder Calculi With Ischemic Heart Disease

Posted on Tue, 10 Jun 2014

Question: hi..... my father's TMT test is positive for inducible myocardial ischaemia.... his exercise tolerance is gud , baseline BP is 130/70 and after exercise for 6.2 minutes it was 170/80 and BPM is 105 his HDL is slightly low i.e., 48 his platelets are low 1.25, his Hb is 15.6, spirometry is normal, chest X-Ray is normal, GB is slightly distended with multiple calculi. what should we do?

Answered by Dr. Hardik Thakker (1 hour later)

Brief Answer:
please read detailed response

Detailed Answer:
Dear XXXXXXX

Greetings from health care magic!!! I am Dr Thakker and shall be answering your question. I can understand your anxiety about your dad's health. I will try my best to help you out.

Since your father has multiple gall bladder calculi, he must undergo a laparoscopic cholecystectomy. He has an underlying ischemic heart disease as well which complicates the matter.

A TMT positive means the heart does not receive enough blood and oxygen during stress. He must undergo a 2 D Echo and then coronary angiography as the final step to determine the blocks in the coronary arteries. He can then be started on medications or stents put as per case.

I would also like to know the ECG findings, fasting, post lunch blood sugars, complete lipid profile, if he has hypertension and diabetes in the past, if he is a smoker, if there is a family history of heart disease.

Fitness for anaesthesia is an issue for your father currently. Once the IHD is corrected, he can then be taken for the lap cholecystectomy.

I hope this helps you out. If you have any more questions, please do not hesitate to write back to me.

Yours sincerely,
Dr Thakker.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Hardik Thakker (4 hours later)

my dad is non smoker,non alcoholic, vegetarian, no family h/o heart disease, he doesn't have HTN, his Bld sugar level (fasting) is 206, ECG is normal HDL is 36, LDL/HDL ratio is 2.2

Answered by Dr. Hardik Thakker (21 minutes later)

Brief Answer:
Please perform PLBS and HbA1C levels

Detailed Answer:
Dear XXXXXXX

Thank you for providing me the relevant information. Your dad has high fasting blood sugar levels. I would want you to have a post lunch sugar and HBA1C levels done. He currently meets 1 of 3 criteria for diabetes. He needs one more to be labelled as diabetic and started on medications. I also wish to know the LDL levels, Triglyceride levels and total cholesterol levels.

Apart from this, his habits and family history are non contributory.

Please get back to me with the above new investigations.

I hope this helps you out. If you have any more questions, please do not hesitate to write back to me.

Yours sincerely,
Dr Thakker.

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Yogesh D