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AFIC medical report recommends by-pass surgery for Musharraf

08 January, 2014

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RAWALPINDI: Medical report of former military dictator, Pervez Musharraf recommended his heart by-pass surgery, media reported on Tuesday.

The report suggested that angiography would be conducted before undergoing by-pass operation.

The complete text of his medical report that produced by Armed Forces Institute of Cardiology (AFIC) is as under.

Case History: General (R) Pervez Musharraf, 70 years of age, presented to the emergency department of this hospital with uneasiness in the chest, sweating and discomfort in left arm at 12.15 PM on 2nd January 2014.

He was non diabetic and normotensive. He was a smoker. His father had died of coronary artery disease.

He had recurrent discomfort around the left shoulder joint and had suffered from frozen shoulder left in the past. He had also been suffering from intermittent pain and stiffness of the lower back due to lumbosacral spondylosis.

His sleep was disturbed on account of nocturia (1-2 times per night) because of an enlarged prostate.

He had dental treatment (root canal and crowning) of right lower mandibular teeth two weeks before admission.

Following this procedure, he had developed pain in the left tempor mandibular joint which was still persisting.

Initial Examination: On physical examination, his pulse was 56 beats per minute (sinus bradycardia) and blood pressure 120/80 mmHg.

Examination of cardiovascular and respiratory systems revealed no abnormality.

There was swelling and tenderness of the left knee joint. Rest of physical examination was unremarkable.

ECG carried out at emergency department revealed sinus bradycardia.

Emergency Treatment: He was hospitalized in coronary care unit and emergency treatment was started' on the lines of acute coronary syndrome, including subcutaneous injection fondaparinux 2.5 mg daily and oral aspirin, clopidogeral, atorvastatin, nitroglycerin, esomeprazole, bromazepam, oxygen inhalation and bed rest.

Investigations and Progress: Echocardiography revealed normal sized cardiac chambers, no segmented wall motion abnormality, good left ventricular systolic function with ejection fraction of 60%, grade 1 diastolic dysfunction and normal heart valves.

24 hours holter electrocardiography revealed heart rate ranging from 49 to 97 beats per minute and ventricular premature beats.

He had raised serum total cholesterol (218 mg / dl ) and LDL cholesterol (150mg/dl). Other laboratory investigatons including serial cardiac enzymes, blood sugar, Serum urea, Creatinine, Sodium, postassium, prostate specific antigen, bilirub,in, AL T and Uric Acid were within normal limits.

During the course of his illness, his chest uneasiness settled but he complained of neck pain, backache, pain left knee joint and discomfort in the left temporomandibular joint.

He was examined by the orthopedic Surgeon. There was tenderness in bicipital groove due to biceps tendinitis. External rotation of the left shoulder joint was painful and diminshed. X-ray knee joints revealed bilateral degenerative changes more pronounced on the left side with left knee joint effusion.

MRI left knee confirmed the presence of joint effusion and osteoarthritic changes. He advised tablet naproxen 500mg BID, ultrasound. Physiotherapy left shoulder and local application of Fastum gel.

Spinal surgeon examined him and found restricted moveme~ts of cervical spine. X-ray cervical Spaine revealed findings of cervical spondylosis. Plain MRI cervical spine revealed central disc bulge at C; 2-C3 and C3~C4, right para central bulgheat C5-C6 causing thecal sac compression and central bulge at C6-C7 level. Cervical spine exercises and physiotherapy were advised.

Dental surgeion advised to continue analgesic therapy for pain in the left temporomandibular joint. Ultrasonography abdomen, kidneys, urinary bladder and prostate revealed benign prostatic hyperplasia (74 grams prostate) for which urologist advised to continue Capsule Flowmax and Tablet Avodart.

Routine frequent daily checkups by the team of senior Cardiologists continued. Further detailed investigations were carried out and treatment was altered accordingly.

Multislice CT angiography revealed densely calcific Triple Vessel Coronary Artery Disease including left mainstem disease (calcium score: total 851.3; left mainstem (LMS) 20.6, left anterior descending coronary artery (LAD) 499.9, left circumflex coronary artery (LCX) 239.6, right coronary artery (RCA) 91.2). LMS: Dense calcification at ostium and distal left mainstem extending into LAD and LCX arteries. LAD: Dense calcification throughout proximal course extending to mid course obscuring the underlying lumen. Another spot of dense calcification distally.

LCX: Dense calcification in proximal course obscuring underlying lumen. Moderate narrowing present beyond the calcification area. Another segment of dense calcification in the mid course.

RCA: Dominant vessel, spotty calcification in proximal, mid and distal course. Subcritical disease in proximal course.

Diagnosis. Densely calcific Triple Vessel Coronary Artery Disease including left mainstem disease.

Diaanosis. In view of the above, he was diagnosed to be suffering from:

Densely calcific Triple Vessel Coronary Artery Disease including left mainstem disease. Hypercholesterolaemia.

Cervical spondylosis and Lumbosacral spondylosis. Biceps tendinitis.Frozen shoulder (left).

Osteoarthrosis with effusion (left knee joint).Temporomandibular Arthralgia (left). Benign Prostatic Hyperplasia.

He is presently undergoing treatment for the above mentioned diseases.

Coronary Angiography is required to optimize the management and to ascertain the possibility of further interventions, like coronary artery bypass surgery.'

End.

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