Cardiology MDT

Dr T.G Mogorosi

10 October 2023
Introduction

• Mr Seabe Moji
• An 85 year old married father of 5; Pensioner
• He is of sober habits; never drank nor smoked
Medical Background

• Known hypertension diagnosed >20years ago; currently well controlled

• TOD:
• Ischemic cardiomyopathy
• NYHA II, CCS 2
• CABG in 2010 in SA, however noted with recurrence of angina since then
• Angiogram done in 2015:
• 30-40% LMCA ( prox- mid), diseased prox to mid LAD followed by total occlusion.
• Distal LAD fills from LIMA. Diffuse disease in LCx and tight mid- PDA lesion. LIMA graft patent, SVG graft not seen.
• PCI to PCA with stent in prox RCA and in mid PDA.
• Still noted with exercise induced angina and coronary and repeated in 2017 and 2019 (nil report)
• Current Meds:
• Isorsobide dinatratte 10mg BD
• Bisoprolol 2.5mg OD
• Clopidogrel 75mg OD
• Aspirin 100mg OD
• Atovostatin 40mg OD Furosemide 40mg OD
• Repeat angio done 12 Sept 2023:
• Stents seen along the length of the RCA and also in mid to distal PDA
• LMCA- mild disease and bifurcates into LAD and LCx
• LAD- tight tandem lesions proximally and diffusely diseased in mid vessel. Thereafter totally occluded,
moderate sized diagonals arise from the diseased mid segment.
• LCx- Non-dominant. There is a moderate sized OM which has only mild disease. LCx after the OM is
diffusely and severy diseased.
• RCA- Dominant vessel and with patent stents in RCA and PDA but with 80% narrowing of proximal
PDA from osmium to the stent in mid vessel
• LIMA- LIMA to LAD patent and perfuses distal LAD. No other grafts seen.
• PCI attempted however abandoned following the patient becaming unstable and going
into bradycardia (resolved with atropine) and then tachyarrhythmias with hypotension.
• Presents with increasing angina on effort x1/12
• Reports history of decreased level of physical activity since previous visit, with
increasing frequency of anginal symptoms with easy fatiguability/ lethargy, more so
that he no longer partakes in household activities. However, denied any leg swelling,
no PND or orthopnea.
• Reports good compliance to medical therapy
• Reports to have reduced modifiable risk factors, including diet which is not inclusive
of high salt and cholesterol foods.
• The patient has not developed any new comorbid illnesses.
Summary Of Investigations
• ECG • Echo
• LVH with EF >60%.
• Trace MR and TR.
• No RWMA.
• RV size normal with tape
1.6cm.
• Normal pericardium.
Case summary

• 85/ Male; known hypertension with TOD of ischemic cardiomyopathy currently on

OMT, baseline NYHA II, CCS 2, with prior CABG in 2010, now with increasing
recurrence of angina on exertion with severe triple vessel disease with patent LIMA to
distal LAD with Eco findings of grade 1 diastolic dysfunction, good LV function no
wall motion abnormalities.
DISCUSSION