Case Study - MA Part 2

MA, the 66 yr old hypertensive, diabetic was diagnosed to have CCF when I saw him. The ECG was unhelpful as he was in pacer rhythm mode. The initial blood test that I did included HB,PCV,TWBC and the Renal profile, and fasting glucometer the next morning. He was given IV frusemide, which resulted in marked urine output and rapid relief of symptoms. Bedside oxygen, and CRIB also help the heart function to stabilised. The CXR done showed cardiomegaly and pulmonary congestion. The echocardiogram showed the pacermaker lead in the RV apex. There was obvious regional wall motion abnormality. The LVEF by 2D was about 30%. There was also mild to moderate MR. The renal profile showed evidence of renal dysfunction ( BU 15 mMols/L, creatinine 330 mMols/L, K+ 4.5 mMols/L ). The F glucometer was 8.6 mMols/L. The fasting total cholesterol was 6.2 mMols/L, LDL-C 4 mMol/L, Triglyceride 3 mMols/L.

1. How would you manage this patient further while he is in hospital?

2. What therapy would you discharge him with when he is ready for home?

3. Do you thing he needs a coronary angiogram?

4. If the angiogram shows significant CAD, would coronary revascularisation help him?

5. What is the role of ACE-I or ARB in the management of this patient?