What Was Done - Procedure Summary

• PTCA = Percutaneous Transluminal Coronary Angioplasty (a balloon procedure to open a blocked artery)
• DEB = Drug-Eluting Balloon - a special balloon coated with a drug (paclitaxel) that prevents the artery from re-narrowing. No permanent stent was left behind - just the balloon was inflated and removed.
• LAD = Left Anterior Descending artery - one of the main heart arteries that was found to have significant disease
• FFR to RCA = Fractional Flow Reserve measurement of the Right Coronary Artery - this is a pressure-wire test to assess if RCA blockage is significant. The result was 0.96 (insignificant) - meaning the RCA blockage does NOT need intervention.
• Approach: Left femoral artery (through the groin)

Operative Findings (What Was Found)

Discharge Medications - What Each Drug Is For

Key Points to Remember

1. Do NOT stop Ecosprin or Brilinta on your own - these two blood thinners are critical after a DEB procedure. Stopping them suddenly can cause a heart attack.
2. Take medications as scheduled - especially Brilinta twice daily, Aztor at night, and Pan before breakfast.
3. Follow-up tests required - the right side of the summary mentions CBC (blood count) and other reports to be done. Keep those appointments.
4. Symptoms to watch for - call the doctor immediately if you experience: chest pain, breathlessness, palpitations, or excessive bleeding/bruising (because of blood thinners).
5. The RCA (right artery) does not need a procedure - the FFR test confirmed it is fine with just medications.
6. No permanent stent was placed in LAD - the DEB leaves no metal behind, which is an advantage (lower risk of clot on foreign material).

Complete Post-PTCA Care Guide

70-Year-Old Male | Hypertension | Post Balloon Angioplasty (DEB to LAD)

1. Blood Pressure - Extra Important at This Age

• Target BP: Less than 130/80 mmHg (post-cardiac procedure)
• He is already on Cilacar T 10/40mg (Cilnidipine + Telmisartan) twice daily
• Check BP at home every morning and evening - keep a diary
• Avoid sudden positional changes (getting up fast) - can cause dizziness at this age, especially with BP medications
• Do NOT skip BP medicines even if he feels fine

2. Blood Thinners - Most Critical Medications

⚠️ Never stop these without cardiologist approval. Even missing 1-2 doses can risk a heart attack in the weeks after angioplasty.

• Unusual bruising or bleeding from cuts that won't stop
• Black tarry stools (internal stomach bleeding)
• Blood in urine
• If any of these occur - call doctor immediately, but do NOT stop the medicines on your own

3. Diabetes Medications - Special Notes at 70

• Glyciphage (Metformin): After a procedure using contrast dye (angioplasty uses iodine contrast), metformin is typically held for 48 hours and restarted only after confirming kidney function is normal. Confirm with doctor if it has been restarted.
• Dapefy (Dapagliflozin): A modern diabetes drug that also protects the heart and kidneys - beneficial in this setting, but ensure he stays well hydrated as it causes some fluid loss through urine.

• Fasting: 100-130 mg/dL
• Post-meal: Less than 180 mg/dL

4. Femoral Access Site Care (Groin)

• Keep the groin puncture site clean and dry for at least 5-7 days
• No heavy lifting for at least 1 week
• Watch for: swelling, redness, warmth, discharge, or a pulsating lump (pseudoaneurysm) at the groin site - report immediately
• Avoid straining at toilet (use laxatives/stool softeners if needed)

5. Activity & Rest

6. Diet Guidance

• Salt: Less than 2 grams per day (no added salt, avoid pickles, papad, namkeen, processed foods)
• Oil: Use minimal oil - prefer olive oil or rice bran oil; avoid ghee and butter in large amounts
• Avoid: Fried foods, red meat, full-fat dairy, coconut oil
• Include: Vegetables, fruits (small portions due to diabetes), oats, dal, fish (not fried)
• Fluids: 6-8 glasses of water daily (important with Dapefy which causes fluid loss)
• Avoid alcohol completely
• No smoking - if he smokes, this is the most important time to stop permanently

7. Warning Signs - Go to Emergency Immediately

8. Follow-Up Schedule

• CBC (Complete Blood Count) - get done as advised
• Other blood reports as mentioned on the right page of the summary
• Cardiology follow-up - typically at 1 week, 1 month, and 3 months post-PTCA
• Echocardiogram / stress test may be advised at 3-6 months

9. Special Considerations at Age 70

• Fall risk: BP medicines + blood thinners together increase bleeding risk from falls. Ensure bathroom has grab bars, avoid slippery floors.
• Kidney monitoring: Contrast dye used during angioplasty can affect kidneys, especially in elderly. Follow up creatinine/kidney function test within 48-72 hours if not already done.
• Mental health: Anxiety and depression are common after cardiac procedures in elderly. Family support is important.
• Polypharmacy: He is on 10+ medicines. Use a pill organiser and a fixed daily routine to avoid missed doses or double doses.

What Is Happening Right Now - The Full Picture

The Chain of Events

Burning urination (UTI starting)
        ↓
Skipped ALL morning medications (dangerous decision)
        ↓
Bacteria spread → Shivering + Fever 103°F + BP 193/84
        ↓
This is NO LONGER just a simple UTI
This looks like UROSEPSIS beginning

🔴 Most Urgent Concern - Skipping ALL Medications Was Very Dangerous

About the UTI - Why It Is Serious at His Age

• Pyelonephritis (kidney infection)
• Urosepsis (bacteria entering the bloodstream) - this is life-threatening

What the RMO should be doing (and you should confirm is being done):

• ✅ Urine culture & sensitivity (to identify which bacteria and which antibiotic works)
• ✅ Blood culture (to check for bloodstream infection)
• ✅ CBC with differential (white cell count)
• ✅ Kidney function (creatinine, urea) - especially since contrast dye was used yesterday
• ✅ IV antibiotics started promptly (do not wait for culture results)
• ✅ Blood pressure monitoring every 30 minutes

About Stopping Dapefy (Dapagliflozin) - RMO Was Correct

• Dapagliflozin (SGLT2 inhibitor) works by making kidneys spill glucose into urine. Glucose in urine feeds bacteria - it worsens UTI and can cause rare but dangerous kidney/urinary infections.
• During active infection, SGLT2 inhibitors also risk a condition called euglycemic DKA (dangerous acid buildup even with normal sugar levels)
• It should remain stopped until the UTI is fully treated and confirmed clear

About the Constipation - The Original Problem

1. Reduced mobility post-procedure
2. Iron / medications - especially the combination of multiple tablets
3. Dehydration - common after angioplasty procedures

Safe solutions that do not conflict with his heart medicines:

• Cremaffin SF 20ml (already prescribed - he has it! "SYP CREMAFFIN SF 20ML" is on his prescription on the right page) - take at bedtime
• Increase water intake - 6-8 glasses daily
• Prunes, papaya, or isabgol (psyllium husk) in water
• Short gentle walks as tolerated

He should NEVER skip heart medicines to manage constipation. The constipation medicine (Cremaffin) was already given to him - he may not have realised it.

What Needs to Happen RIGHT NOW

1. Resume ALL missed heart medications immediately (Ecosprin, Brilinta, BP tablets, Nikoran, Monotrate) - inform the RMO that he skipped morning doses and get guidance on catching up
2. IV antibiotics for UTI/urosepsis - should be started at hospital
3. Urine and blood cultures - must be sent before antibiotics if not already done
4. Continuous BP monitoring - 193/84 must come down carefully (not too fast)
5. Do not discharge until fever and BP are controlled - given his post-angioplasty status, he should stay admitted overnight minimum

One Critical Message to the Family

A 70-year-old man, just 1 day after balloon angioplasty, with fever 103°F, shivering, and BP 193/84 should not be managing this at home. He needs to remain in hospital under observation tonight. The combination of active infection, very high BP, and being on blood thinners is high-risk. Please insist on admission if the RMO is considering sending him home.