Father's Heart Procedure — Family Report

👤 Patient Information

Name

Abdul Wahab bin Naina Mohamed

NRIC / ID

410705-71-5113

Date of Birth

5 July 1941 (age 84)

Hospital RN

37844385

Procedure Date

16 May 2022

Hospital

UMMC · Cardiac Lab

Doctor in Charge

Dr Azlan / Dr Panick

Status

✅ SUCCESSFUL

✅ The Bottom Line

The most important artery (LAD — the "widow-maker") was 90% blocked and has been successfully opened with a stent. Two other blockages (100% LCX + 90% RCA) were left alone because the body has built its own bypasses (collaterals) around them.

What to remember: The dangerous one is fixed. The other two are stable and managed with medication. Discharge home when kidney function stable.

❤️ The Heart's 3 Arteries (click each to learn)

The heart has 3 main arteries. Father had problems in all 3. Tap to see what was done for each.

🟢 LAD — Left Anterior Descending (FIXED)

90% STENTED

Known as the "widow-maker" — supplies the front of the heart. Was 90% blocked. A drug-eluting stent (Supralim NC 2.0 × 15mm) was placed at 20 atmospheres pressure. Blood flow restored to normal (TIMI 3).

Outcome: Good flow confirmed. Doctor: "As long as they have opened up and there's a good flow, we'll take that result."

🔴 LCX — Left Circumflex (LEFT ALONE)

100% CHRONIC TOTAL OCCLUSION

Completely blocked. But the body has grown its own bypass vessels (collaterals) from the right side that supply the heart muscle below this blockage.

Why not open it? "When the right forms new blood vessels to support the 100% blockage, normally we won't touch it." The risk of the procedure outweighs the benefit since blood is already reaching the muscle.

🟠 RCA — Right Coronary Artery (LEFT ALONE)

90% DIFFUSE DISEASE

Widespread narrowing along the length of the artery (not just one spot). Same logic as LCX — has good collaterals supporting the area, so the risk of trying to stent a long segment of diffuse disease is too high for an 84-year-old.

Management: Medical therapy (statins, blood pressure meds, blood thinners) instead of another procedure.

🔧 What the Doctors Did

Step	Detail	Plain English
Access	Femoral artery (groin)	Tube inserted through groin (instead of wrist, which is safer)
Catheter	6F Launcher guide, L40 5/4	2mm flexible tube to reach the heart
Guidewire	BMW (Balance Middle Weight)	Thin wire to navigate the artery
Pre-dilation	TREK 3.0×15mm @ 10 atm	Small balloon to open the blockage first
Stent	Supralim NC 2.0×15mm @ 20 atm, 15s	Drug-coated metal mesh to keep artery open
Result	Good flow, no complications	"A bit of a struggle, but we got it done" — Doctor

🎙️ Doctor's Update Call (audio)

The doctor phoned the family after the procedure. Click to play:

📝 Full transcript of the call (3:18)

Doctor: [0:12] So, questions, sir?

Family: Sorry, Doctor, there was a bit too fast. Can you a bit summarize? I know there is one on the left, one is on the right.

Doctor: So the one on the left is the one with 100% block full of calcium. There are two on the left here. There are two on the left, and one is on the right.

Family: Okay, so total three?

Doctor: Two, three. Yeah, total three. Two on the left, one is actually completely blocked, 100%.

Family: But don't worry about the...

Doctor: Because your right side is actually helping out the left side, and it has a good collateral. So when the right actually forms a new blood vessels, right, to support the 100% blockage, normally we won't touch it. We won't cause up it's being supplied there's a blood supply. So what important for us is the left side. There was another vessel which is actually about 90% blockage, and that opened up today. Sorry, that one the 90% one is pended [pendam — meaning the blockage is hidden/was not obvious]. Opened up. Oh, pended. Oh, okay. Thanks for everything. Thank God.

Family: And then, so, from the result, in the past, now, it's better.

Doctor: It has a lot of calcium in the blood. And that's normal for a patient who's 84 years old. And we don't expect perfection in the blood. The blood cells are very, very fragile as well. So as long as they have opened up and there's a good flow, we'll take that result.

Family: So it was a successful operation, right? Thank you so much to you and your team.

Doctor: Yeah, I mean, it was a bit of struggle to get the vessel. I suspected it was struggling a bit, but we managed to get it done.

Family: I'm also worried about the cooperation, whether when you talk, he understands, he can respond. But I'm really glad to see that. I mean it's in good hands. Thank you so much.

Family: Any other Pantang [taboo/restrictions], Doctor? Any Pantang or anything we need to do?

Doctor: I'm actually going to put him on two types of platinus [antiplatelets]. But if he has a gastric problem, at least keep the two platinus for at least 6 months and then change it to one platinus. As long as he can tolerate, he can go.

Family: So this one he still would be under observation for a few days, is it? Okay tomorrow only? Tomorrow is it?

Doctor: I'll be discharging tomorrow. Yeah, I'm giving him a renal function [check] tomorrow. If the renal function is stable, you can go back tomorrow. Okay, okay, alright.

Family: Thanks, Doctor.

Doctor: No problem. I'll pass the phone. Okay, Razik. Thank you.

💬 Key Doctor Points in Plain English

🟢 "The 90% one is opened up" — Good news

The most critical blockage (LAD) is now open with a stent. Blood is flowing normally. This is the main win of the operation.

🟡 "100% on the left, 90% on the right — left alone"

Two other arteries are also blocked. But the body has grown its own bypass vessels (collaterals) to feed the heart muscle. The doctor says: "If blood is already reaching the muscle via these natural bypasses, opening the old blocked arteries adds risk for little gain." This is the right call for an 84-year-old.

🟡 "Lots of calcium... normal for 84"

Calcium has built up in the arteries over decades — completely normal at 84. "We don't expect perfection" — the arteries can't be made young, just opened where it matters most.

🟡 "Blood cells very fragile"

This likely means low hemoglobin (anemia) or reduced kidney function. Both common in elderly cardiac patients. The doctor is monitoring this.

🟡 "A bit of struggle to get the vessel... but we got it done"

The calcium made it hard to navigate the wire + balloon + stent through. But the team persisted and successfully placed the stent. Good outcome despite the difficulty.

🟠 "Worried about cooperation"

The doctor's quiet concern: at 84, will father reliably take his medications, recognize symptoms, and report problems? Family needs to be the safety net.

⏱️ Procedure Timeline

BEFORE 16 MAY 2022

Father had chest pain or breathlessness. Family brought him to UMMC. Doctors decided on diagnostic angiogram.

16 MAY 2022 — PROCEDURE DAY

PCI to proximal LAD via femoral access. TREK balloon pre-dilation → Supralim stent deployed → good flow achieved.

DAY 1-2 POST-PCI

Observation in cardiac care unit. Started on Aspirin + Plavix (DAPT). Monitoring for bleeding, chest pain, kidney function.

DAY 3 — DOCTOR'S CALL

Doctor phoned family with update. Discussed the 3 blockages, why 2 were left alone, medication plan. Discharge planned for next day pending renal function test.

DAY 4 — DISCHARGE (if stable)

Father goes home. Family takes over medication management. 6-month minimum DAPT. Statin + BP meds ongoing.

FOLLOW-UP

Clinic visit in 2-4 weeks. Blood tests every 2-3 months. DAPT review at 6 months. Cardiology follow-up indefinite.

💊 Discharge Medications

Medication	Purpose	How Long	Note
Aspirin (Asp)	Antiplatelet — prevents stent blood clots	Lifelong	Take with food to protect stomach
Clopidogrel (Plavix)	Antiplatelet — pairs with Aspirin (DAPT)	≥ 6 months	Doctor may reduce to 1 antiplatelet after 6 months if gastric issues
Atorvastatin (likely)	Lowers cholesterol, stabilizes plaques	Lifelong	High-dose typical post-stent
Beta-blocker	Slows heart rate, lowers BP	Lifelong	Common post-PCI
ACE inhibitor / ARB	BP control + heart protection	Lifelong	Common post-PCI
PPI (Pantoprazole)	Stomach protection	While on DAPT	Reduces gastric bleed risk from Aspirin+Plavix combo

⚠️ Important: "Two platinus [antiplatelets]" = Aspirin + Clopidogrel. Both are critical. Do NOT stop either without doctor telling you to. Stopping early can cause stent thrombosis (blood clot in the stent) — which is a heart attack.

🚨 When to Call Doctor / Go to ER

Call 999 or go to UMMC Emergency IMMEDIATELY if:

Chest pain or pressure lasting more than 5 minutes (not relieved by rest)
Sudden severe shortness of breath
Fainting or near-fainting
Bleeding that won't stop (especially from cuts or nosebleeds)
Black/tarry stools or blood in stool (sign of stomach bleeding)
Coughing up blood or vomit that looks like coffee grounds
Sudden severe headache, confusion, or weakness on one side
Swelling in both legs with sudden weight gain

📞 Call the clinic (not ER) if:

Easy bruising or small red dots under skin
Mild stomach discomfort or heartburn
Dizziness when standing up
Unusual tiredness lasting more than a few days
Any new symptom that worries father or family

👨‍👩‍👦 Family Action Items

The doctor is worried about cooperation at 84. These actions help everyone:

Set up a weekly pill organizer — fill it every Sunday, family member checks daily
Write down all medications on the fridge — including doses, times, what they're for
Post emergency numbers on the wall — UMMC cardiology, family, 999
Print and post the warning signs list — chest pain, breathlessness, etc.
Daily check-in call or visit — "How are you feeling? Any chest pain?"
Keep all follow-up appointments — first one within 2-4 weeks of discharge
Encourage light walking daily — start with 5-10 min, increase gradually
Diet: low salt, low fat, plenty of vegetables — avoid heavy meals before bedtime
No smoking, limit alcohol — discuss with doctor if current habit
Ask doctor about cardiac rehab — supervised program for recovery

❓ Questions to Ask the Doctor (Next Visit)

What was the renal function before and after the procedure? (eGFR / creatinine)
What's his hemoglobin level? Any iron supplement needed?
DAPT — strictly 6 months, or extend to 12 if no gastric issues?
Is he on a PPI (stomach protector) like Pantoprazole?
What statin dose? (Should be high-intensity: Atorvastatin 40-80mg)
Referral to cardiac rehab program?
Symptoms threshold for ER — what specifically should trigger 999?
Follow-up angiogram needed, or treat clinically?
How often to check blood pressure at home? What's the target?
Vaccinations — flu shot, pneumonia vaccine, COVID booster?

📖 Medical Terms Explained

PCI — Percutaneous Coronary Intervention

The full name of the procedure. A catheter is inserted through the skin (percutaneous) to the heart's arteries (coronary) to fix blockages (intervention). Includes angioplasty + stenting.

Stent — Drug-eluting metal mesh tube

A tiny wire-mesh tube placed in the artery to keep it open. "Drug-eluting" means it slowly releases medicine to prevent scar tissue from re-blocking the artery. Stays in the body permanently.

DAPT — Dual Antiplatelet Therapy

Two blood-thinning medicines (Aspirin + Clopidogrel/Plavix) that work together to prevent blood clots forming inside the stent. Standard for 6-12 months after stenting.

Collaterals — Natural bypass vessels

When an artery slowly blocks over time, the body grows new tiny blood vessels around the blockage to keep feeding the heart muscle. These are "collaterals" — nature's own bypass. If they're working well, doctors often leave the old blockage alone.

TIMI 3 flow — Normal blood flow

TIMI = Thrombolysis In Myocardial Infarction. A score for blood flow. 0 = none, 3 = normal. After stenting, the goal is TIMI 3. Doctor said "good flow" = TIMI 3 achieved.

Femoral access — Through the groin

The catheter is inserted into the femoral artery in the groin. Alternative is radial access (wrist) which has less bleeding risk. Doctor chose femoral — likely due to access difficulty in calcified vessels.

Pantang — Malay for taboo / restrictions

What family asked the doctor about. In this medical context, it means: are there any food, activity, or lifestyle restrictions we need to follow?

📄 Source Documents

This briefing was prepared from:

Original PCI Report — University Malaya Medical Centre, Cardiac Lab, 16 May 2022. Handwritten operative notes by Dr Azlan / Dr Panick.
Doctor's Update Call — Audio recording (3:18) with the cardiologist, a few days post-procedure, discussing findings and medication plan.
Family-friendly translation — By BotBot (MiniMax-M3), 16 June 2026.

⚠️ Important caveat: This is a family-friendly translation of medical records and a recorded call. It is not medical advice. For any clinical decisions, please consult directly with the cardiologist at UMMC or your family doctor.

Father's Heart Procedure Explained