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EECP vs Other non surgical options
EECP vs Better Non-Surgical Options: 61F Post-Pulmonary Edema (TVD, 42% EF)
61F. Frail/thin. Hospitalized last week for 1st time with acute pulmonary edema (now resolved). Currently stable: lungs clear, SpO2 98%, Pulse 82-85, FBS 155, PPBS 198. Has intense thirst and fragmented sleep.
Angiogram: Severe TVD. LMCA 30-40% stenosis; LAD total occlusion (filling via active collaterals); Distal LCX 90-95% stenosis; RCA total occlusion (retrograde filling). Surgeons advised against CABG/PCI due to frailty; recommended medical management as collaterals are compensating.
2D Echo: EF 42%, mild PAH, multiple hypokinetic LV segments. Chambers/IVC normal.
Meds: Axcer 90mg BID, Aspirin AV 75/40, Bisoprolol 1.25mg, Angispan 2.6mg, Oxra 10mg, Tab Leni 40mg (1.5 tabs/day). NovoRapid (10-10-8) + Lantus (10u at 10 PM). Strict 1L fluid limit, zero-salt diet.
Questions:
Can EECP safely mature her collaterals, or does increased venous return risk re-inducing pulmonary edema so soon?
EECP can be done as a last resort therapy if CABG is not being done. It stimulates the opening and growth of small collateral blood vessels (collateral circulation) to naturally bypass blocked heart arteries. Decreases the frequency and intensity of stubborn angina episodes that do not respond well to medications alone. Increases your ability to exercise and perform daily physical activities with less shortness of breath and fatigue.
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