patient smt sumitra devi ,female ,67years old lady ,known diabetic type 2 ,non hypertensive ,H/o CAD unstable angina ,Tmt Positive , S/p CAG [17.5.10] kameneni ,LMCA +triple vessel disease ,good LV function , treated at care hospital banjara for 44 days and presently readmited at hiranandani hospital ,mumbai , for brethlessness and drowsy , kept on Bi pap support , with minimal support , sp02- 99, RR -17, HR 77, BP -134/77 , on pyridostigmine , a know case of occular myopathy , with type 2 respiratory disorder , looks to be musculat distrophy , needs further management ,looking for what can be the suitable offer to the patient , pl advice