Suggest treatment for ischemic heart, chest pain and breathing problems
Patient: patient is suffering from angiodysplesia(obscure G.I.bleeding) for 8yrs. she has low haemoglobin level at around 7.5-8%. has to be transfused blood every 4-5 mths. she has been diagnosed with ischemic heart...chest pain, breathlessness in performing daily chores and especially climbing bed. pls advice Doctor: Thank you and pleased to answer you.The term intestinal angiodysplasia has been defined as a superficial acquired single or multiple acquired vascular lesion developed in the mucosa and / or submucosa of the gut wall without being associated with a cutaneous or visceral angiomatous lesion. The etiology and pathophysiological mechanisms leading to the formation of angiodysplasia are not yet fully understood. A hypothesis developed by Boley is the appearance with age of a chronic partial obstruction of the submucosal veins in connection with an increase in contractions of the muscular layer of the colon wall. Investigations leading to the diagnosis of angiodysplasias are closely related to the clinical presentation and severity of digestive bleeding. The development of endoscopy techniques and the quality of video endoscopes used, particularly in terms of image resolution, make endoscopy the first pathway for the diagnosis of angiodysplasias. Treatment is indicated when there is external bleeding or when the bleeding is occult, after eliminating any other cause of bleeding. Asymptomatic I mean non-haemorrhagic, angiodysplasias of incidental discovery should not be treated. The principle of argon plasma coagulation treatment is based on the simultaneous release of an electric current and a gas, argon, which in its ionized form will destroy, in a targeted way and without contact (3 to 5 mm Of distance), the superficial mucosa (0.5 to 3 mm deep), destruction done with an electric arc. It is the reference technique for the destruction of angiodysplasias, whatever the location. Electrocoagulation treatment, or coagulation of angiodysplasias with hot forceps, was performed in the 1980s but is no longer recommended because of the high risk of perforation.The patient also has anemia following recurrent bleeding, and therefore what explains the symptoms. However, treatment is not only based on transfusions, but also on argon plasma coagulation to stop hemorrhage. A recent retrospective study showed a significant reduction in transfusion requirements in all patients treated with argon plasma coagulation. However, hemorrhagic recurrence occurred in 42% of patients after an average follow-up of 4.5 years.In this patient, the anti-aggregation treatment for ischemic heart disease should not be interrupted because of the risk of harming her life expectancy.The heart procedure indications which formally require further anticoagulant treatment may lead discussions with the patient, the surgeon and the cardiologist about the indication of a segmental intestinal surgery.May this informations help youBest wishes