01-18-2009, 04:15 PM
A 55-year-old man has progressive, unstable, disabling angina that does not respond to medical management. His father and 2 older brothers died of heart attacks before the age of 50. The patient stopped smoking 20 years ago, but has a sedentary lifestyle, is a bit overweight, has type II diabetes mellitus, and has high cholesterol concentrations. Cardiac catheterization demonstrates 70% occlusion of 3 coronary arteries, including the anterior descending, with good distal vessels. His left ventricular ejection fraction is 55%. Which of the following is the best therapy for this man?
A. Angioplasty and stenting of all affected vessels
B. Continued medical management until occlusion levels exceed 90% or ejection fraction becomes less than 35%
C. Intensive medical therapy to bring his ejection fraction to more than 85% and allow surgical coronary revascularization
D. Triple coronary bypass using the internal mammary artery for the anterior descending graft, and saphenous vein for the others
E. Triple coronary bypass using saphenous vein for all the grafts
A. Angioplasty and stenting of all affected vessels
B. Continued medical management until occlusion levels exceed 90% or ejection fraction becomes less than 35%
C. Intensive medical therapy to bring his ejection fraction to more than 85% and allow surgical coronary revascularization
D. Triple coronary bypass using the internal mammary artery for the anterior descending graft, and saphenous vein for the others
E. Triple coronary bypass using saphenous vein for all the grafts