Name: NASSER AL RAHBI

Age & Sex:72M

Date of Admission: 06.03.2009   

Date of Discharge: 31.03.2009


DIAGNOSIS:

1. CAD-TVD (CART-31.01.09)
2. LVF/Pulmonary edema, one episode
3. EF 30%; AOE-Class III

Patient came with angina on minimal exertion since last 3 months. Inspite of medications he did not get any releif. CART at Royal Hospital Oman revealed severe TVD with an EF of 30%. Advised CABG which he refused. He came to us with a request for noninvasive management of CAD-stable angina.

Invasive, very effective treatment oWe gave him 35 one hour sessions of EECP over a period of thirty days.  (EECP is a USFDA approved, external, nonf CAD.)     

Under the all inclusive Aggressive Medical Treatment(AMT) we did the following

1.     High dose statins-Atorvastatin 80 mg daily.
2.     ACE inhibitors-full dose titrated to a BP of just above 100 systolic.
3.     Full dose Beta blockers titrated to a pulse rate of just under 60.
4.     Zero fat diet + 1 Kg of raw fruits and salads + 100 gm of steamed fish + complete avoidance of dairy products + 200 ml of fruit juice + cereals restricted to 100 gms per day + 200 gms of boiled vegetables + 50 gms of boiled pulses/lentils + 30 gms dry fruit.
5.     Graded, gradually progressively increasing, exercise, under supervision.
6.     Yoga and meditation to reduce stress levels.
7.     The aim of all this was to reduce his LDL levels to less than 70 mg.