[HSF] CAD in septogenerian diabetic with LVD

[erdinç naseri]

Opinion requested for the following case:
71 Y/O male,DM diagnosed 10 yrs ago( on oral antidiabetics),admitted for SOB(class III NYHA) which has continually worsened in the past several months.
Total loss of vision due to diabetic retinopathy( 2 yrs ago)
EKG: Old inferior MI
Echo:EF 20% ( Simpson's ),inferior akinesia,septal akinesia,anteroapical hypokinesia,MR ++(good depth of coaptation with central leak, good leaflet mobility),TR+++ , Mean PAP 45 mmHg,AR( minimal)
CAG( 10 months ago):LAD diffuesly diseased,RCA totaly occluded .Operation refused by the patient at that time .
Planning to do Dobutamine stress Echo as viability study( myocardial scintigraphy 150 kms away)
erdinc