Case Studies

Mr Somashekaran Nair 55 years Male patient who was a KSRTC Driver, had his first heart attack in May 2004, He got admitted in the General Hospital Thiruvananthapuram where he was diagnosed of a severe anteriolateral wall MI (Heart Attack). After stabilization he was referred to the referral academic institute for  further interventional or surgical treatment. In the following angiography performed  he was diagnosed with a Triple vessel disease and severe LV dysfunction and was deemed unsafe for surgical intervention. He was on a fluid restriction due to the transient – Acute Tubular necrosis sustained to his kidney during the heart attack. 
His was referred for Cardiac Viability assessment to our centre DDNMRC Pvt Ltd for Myocardial Perfusion scintigraphy in which there was severe non reversible infarction of the Anterio Inferio walls with severely compromised LV function nearing 10 – 12 % with global hypokinesia and segmental akinesia. A MUGA study was conducted to evaluate his absolute function which also revealed the same findings. Clinically the patient was severely breathless at rest (Class IV), with severe Orthopnoea. There was no gross odema.
After undergoing 35 cycles of EECP patient improved tremendously with his symptoms improving drastically from Class IV – Class I and Fluid intake increase with normalization of renal function. Skin perfusion returned to normal with normal sweating being re-established. His Orthopnea had completely disappeared, and his function had improved drastically to 32%. There was a reversibility of rest perfusion of 13% in the anterior wall and 15 % in the lateral wall. The patient could climb 4 floors without stopping and chest discomfort compared to less than 5 steps before commencement of treatment.