Medical History Ms. RW is a 58-yr. old woman with no prior history of heart dise
ID: 121867 • Letter: M
Question
Medical History Ms. RW is a 58-yr. old woman with no prior history of heart disease. She has hypertension under good control with medications and was diagnosed with diabetes 15 yr. ago. Her last fasting blood glucose was 234 mg/dl, and her HbA1c was 8.7%. She is a former smoker (quit 10 years ago) and leads a rather sedentary lifestyle as a computer analyst for a large local firm. Over the past 3 months she has started to notice increased shortness of breath when climbing two flights of stairs at work; at the top of the stairs, she feels some moderate chest pressure that resolves in a couple of minutes after she sits down at her desk. Her primary care physician sends her for a routine exercise stress test. Exercise Test Results: She exercises on a standard Bruce protocol. At 4:30 min there is some horizontal ST depression, about 1 mm in inferior and lateral leads; by peak exercise (5:20) it is about 2 mm downsloping in the same leads, and she is developing chest pressure she described in her symptom history. ECG changes resolve by 10 min of recovery, and symptoms resolve in about 5 minutes of recovery. Resting ECG: Appears normal Heart rate: 65 bpm Blood pressure: 138/92 mmHg Heart and lung sounds: within normal limits Diagnosis: Severe two-vessel CAD. Stenting was performed to 95% occluded proximal left anterior descending coronary artery lesion. Ms. RW’s 75% occluded distal left circumflex lesion was not a candidate for revascularization at the time of the procedure. Medications: Metoprolol (beta-blocker) 50 mg twice daily; linsinopril (ACEi) 10 mg once daily, asprin, plavix (anti-platelet), and simvistatin.
1) What changes may have to be made to the patient’s exercise regimen in view of the residual 75% blockage in her left circumflex coronary artery?
Explanation / Answer
Coronary collateral vessels serve as natural protective mechanisms to provide coronary flow to enhance myocardial activities. A well developed collateral circulation has been documented to exert protective effects upon the myocardial perfusion ,Contractile function,infarct size and ECG abnormality thus therapeautic augmentation of collateral vessels development in case of the above patient will help in the overall cardiac output of the patient .studies have proved that an eight weeks trained exercise regimen to patients have lead to improved cardiac perfusion .exercise increses H2O2 which contributes to vasodilation among the patients .Before an exercise regimen is advised Pateint should undergo a graded excercise test or ETT.
The different exercise regimen of the above patient considering her disease condition and co morbidities It should include the following