Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I carefully passed through your question and would explain that this is a common complication after coronary angiography.

It is related to local inflammation in the region of catheterization (femoral sheath), which is closely related to the nerves which innervate the urinary bladder.

The irritation of the nerves which pass nearby to the region of catheterization, can lead to bowel disorders and urinary retention.

But, it is important differentiating if this is a real urinary retention (where the urinary bladder is full) or renal insufficiency, related to the contrast injection (in such case the urinary bladder would be empty).

So, I recommend you to consult your father with his attending physician for a careful physical exam and put a urinary catheter.

This would help differentiate if it is just retention or a renal problem. From the other hand, in case of urinary retention, this would also be the treatment choice (to help release his urinary bladder empty and relieve his discofort).

In case the urinary bladder is empty, further tests may be needed to examine his kidneys:

- an abdominal ultrasound
- kidney function tests.

You should discuss with his doctor on the above issues.

Hope you will find this answer helpful!

Feel free to ask me again, whenever you need!

Kind regards,

Dr. Iliri

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Brief Answer:
I would explain as follows:

Detailed Answer:
Dear XXXXXXX

I understand your father's clinical situation and would explain that considering the doctor recommendation for coronary revascularization procedure (bypass surgegy or angioplasty), I would recommend to perform one of this procedures.

Let me explain that each one of these treatment strategies ( bypass or angioplasty) could be a good alternative.

Your father cardiac function is not too low. With such a value of LFEF of 40%, he could cope quite well with the surgery. But you should know that cardiac surgery is a major procedure that may impose to potential complications such as cerebral, renal or even infections (mediastinitis).

When considering surgery a thorough investigation for any present comorbidities should be performed.

Surgery is also performed through chest wall opening, which can be really traumatic (physically and psychologically) for your father.

Bypass surgery would be recommended in the presence of very complex coronary lesions, such as stenosis of left main coronary artery, left main segment or a three vessel disease.

From the other part, percutaneous angioplasty could provide another useful alternative for treating coronary blockage without undergoing the risks of surgery (trauma, infection, etc.).

The patient undergoing angioplasty could have the same benefits of surgery and what is most important his post-procedure recovery would be much faster, more comfortable (non-traumatic) and would be discharged much earlier from the hospital; features that bypass surgery can not offer in generally.

So, on my personal opinion, if those coronary lesions are treatable through angioplasty, I would recommend trying this strategy, which would be also more preferable at your fathers age.

Hope to have clarified your uncertainties!

Wishing all the best,

Dr. Iliri

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Brief Answer:
My answer as follows:

Detailed Answer:
Dear XXXXXXX

It is true that conservative therapy (with drugs) is one of the treatment options. It can relieve his symptoms and improve his physical performance and thus his life quality.

BUT, this treatment option does not offer the opportunity to definitely avoid the occurrence of clinical symptoms of cardiac ischemia.

In other words, though your father could follow a properly tailored medical therapy, he may experience recurrent episodes of chest pain, that may lead to important limitations in his daily physical activity.

But, what is worse is that an ongoing cardiac ischemia may lead to a true acute coronary syndrome with a subsequent clinical scenario of unstable angina or acute myocardial infarction.

These latter consequences are serious complications and may be even lifethreatening.

Now returning to your concrete question, I would explain that a full anti-ischemic therapy should include different drug classes such as:

- beta-blockers (like bisoprolol, metoprolol, etc.)
- nitrates (like isosorbide dinitrate or mononitrate, nitroglycerine, etc.)
- anti-platelet agents (aspirin, clopidogrel, etc.)
- vasodilators ( ACEI like ramipril, lisinopril, perindopril, etc. or ARBs like candesartan, irbesartan, etc.)
- anti-lipemiants (atorvastatin, simvastatin, etc.)
- additional drugs like ranolazine, trimetazidine, etc..

You should discuss with your doctor on the above issues.

Hope you will find this answer helpful!

Regards,

Dr. Iliri

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