A Case of Heart Failure due to Triple Vessel Coronary Artery Disease: Role of General Practitioner
DOI:
https://doi.org/10.22219/sm.Vol18.SMUMM2.17370Abstract
Heart failure with reduced ejection fraction (HFrEF) is a complex clinical syndrome characterized by a left ventricular ejection fraction ≤ of 40%. Primarily the etiology of heart failure is due to coronary artery disease (CAD). Patients with multivessel disease are considered for revascularization procedures with coronary artery bypass grafting (CABG). We report patient with HFrEF due to three-vessel disease (3VD) is not indicated for revascularization and only gets a conservative therapy to improve the patient's quality of life. A 52-year-old man visited the cardiologist to get control his condition. The patient experienced shortness of breath, heartburn, cold sweat, and fatigue. The physical and blood examination was normal, electrocardiography showed fragmented QRS complex, V1-V3 poor R waves progression, and V5-V6 T waves inverted. The echocardiography showed a result of ejection fraction is only 30%. He was treated with acetylsalicylic acid, bisoprolol, valsartan, furosemide, nitroglycerin, spironolactone, and isosorbide dinitrate. Treatment with CABG was not carried out. The ejection fraction was raised to 40% and he was clinically improved. HFrEF due to CAD3VD could be treated with fully conservative therapy and not indicated for revascularization treatment because of coronary anatomy and myocardial viability. A comprehensive approach should be evaluated by Heart Team.
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De Innocentiis C, Zimarino M, De Caterina R. Is complete revascularisation mandated for all patients with multivessel coronary artery disease?. Interventional Cardiology Review. 2018 Jan;13(1):45.
Ezekowitz JA, O'Meara E, McDonald MA, Abrams H, Chan M, Ducharme A, Giannetti N, Grzeslo A, Hamilton PG, Heckman GA, Howlett JG. 2017 Comprehensive update of the Canadian Cardiovascular Society guidelines for the management of heart failure. Canadian Journal of Cardiology. 2017 Nov 1;33(11):1342-433.
Hawranek M, Zembala MO, Gasior M, Hrapkowicz T, Pyka Ł, Cieśla D, Zembala M. Comparison of coronary artery bypass grafting and percutaneous coronary intervention in patients with heart failure with reduced ejection fraction and multivessel coronary artery disease. Oncotarget. 2018 Apr 20;9(30):21201.
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P. 2018 ESC/EACTS Guidelines on myocardial revascularization. European heart journal. 2019 Jan 7;40(2):87-165.
Nurkhalis N, Adista RJ. Manifestasi Klinis dan Tatalaksana Gagal Jantung. Jurnal Kedokteran Nanggroe Medika. 2020;3(3):36-46.
Piterman L, Yang H, Yin Z. Chronic heart failure: Role of the GP in management. Family Medicine and Community Health. 2018 Feb 1;6(1):3-9.
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European heart journal. 2016 Jul 14;37(27):2129-200.
Setiawan AA, Panggabean M, Yamin M, Setiati S. Kesintasan Lima Tahun Pasien Penyakit Jantung Koroner Tiga Pembuluh Darah dengan Diabetes Melitus yang Menjalani Bedah Pintas Koroner, Intervensi Koroner Perkutan atau Medikamentosa di Rumah Sakit dr. Cipto Mangunkusumo. Jurnal Penyakit Dalam Indonesia. 2016 Jun 30;3(2):60-6.
Shahani R. Coronary Artery Bypass Grafting. 2019. [cited 2021 May 26]. Avalaible from https://emedicine.medscape.com/article/1893992-overview
Siswanto B.B., et al. 2020. Pedoman Tatalaksana Gagal Jantung. Publisher: Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI).
Straw S, McGinlay M, Witte KK. Four pillars of heart failure: contemporary pharmacological therapy for heart failure with reduced ejection fraction. Open Heart. 2021 Mar 1;8(1):e001585.
Wolff G, Dimitroulis D, Andreotti F, Kołodziejczak M, Jung C, Scicchitano P, Devito F, Zito A, Occhipinti M, Castiglioni B, Calveri G. Survival benefits of invasive versus conservative strategies in heart failure in patients with reduced ejection fraction and coronary artery disease: a meta-analysis. Circulation: Heart Failure. 2017 Jan;10(1):e003255
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