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Let the patient decide.(5-MINUTE CONSULT)
A COUPLE OF YEARS AGO, I followed two patients who were in similar circumstances: Both had chest pain (angina) from a partially blocked heart vessel. They were very active seniors who wanted to remain that way. But they were also concerned about risks and possible disability as a result of either the disease or the treatment.
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The cardiologist and surgeon involved in both cases believed, as I did, that revealing all options was best. Here are the treatment choices explained to each patient:
* A conservative approach would be to prescribe medications that lessen the frequency and severity of pain. I'd prescribe medications to lower blood pressure and cholesterol and to treat other conditions. The patient would have to be careful when exercising but could remain active.
* A more aggressive approach would be to clear the blockage with angioplasty, insert a stent if needed, and prepare the patient for the possibility of taking blood thinners for life. If the procedure was successful, the patient could return to normal activity, but an artery could become blocked again.
* The most aggressive approach would be bypass surgery to clear the blockage. If the surgery was successful, the patient could return to normal activity, but the procedure could pose serious health risks, including a heart attack.
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