A 72 year old diabetic retired staff nurse from govt hospital was advised knee joint replacement. On her preoperation investigations it was found that she had chronic total occlusion of LAD( left anterior descending) artery on cor angiography. Besides slight fatigue and breathlessness on marked exertion she does not have any cardiac symptoms.She has been advised CABG(Coronary artery bypass grafting) by cardiologist prior to undergoing knee joint replacement.PTCA(Percutaneous transluminal coronary angioplasty) has been ruled out due to heavy calcification in coronaries.Her EF(Ejection fraction) on 2D Echo is 40-45%.
Patient does not want to undergo CABG and ready to do away with knee joint surgery.Valuable opinion regarding further line of treatment- 1.Inspite of her age and long stanging diabetes and mild to moderate cardiac symptoms should she undergo CABG later on knee replacement. 2.…
