Patient Case Reports
NB: These are some of the case reports of cardiac patients who underwent treatment with Dr Mohanlall & Partners, trading as South African External Counterpulsation at 325 Umhlanga Rocks Drive, Umhlanga, Durban, KZN, South Africa.
1. A 65 year old gentleman had undergone coronary artery bypass graft (CABG) surgery nine years ago. Despite undergoing a bypass and being on medical therapy, he continued to experience chest pain (angina CCS class 3) and shortness of breath (NYHA grade III). He was unable to walk up a flight of stairs to reach his post box without stopping to rest. He also suffered from hypertension and non-
2. A 69 year old male, experienced his first episode of a heart attack twenty four years ago and then underwent coronary artery bypass graft (CABG) surgery eighteen years ago. However, he developed a recurrence of chest pain two years after the bypass surgery, and investigations revealed triple vessel blockage of his coronary vessels yet again. He was told by his cardiologist that he was not a candidate for a second bypass and was placed on adjunctive medical therapy. He still experienced chest pain, and was classed as having angina CCS class 4 anginal symptoms. He also suffered from hypertension, non-
3. Mr 59 year old male, suffers from coronary artery disease. He suffered a heart attack in 2010, and was on medication. He also suffered from hypertension. Despite being on medical therapy, he still experienced recurrent episodes of chest pain and was diagnosed as having angina CCS class 2 symptoms. He often became short of breath on minimal exertion (NYHA grade IV). The course of treatment decided by his cardiologist was that of maximizing his medical therapy and reviewing his health status again two months later for cardiac angiography with view of revascularization. He subsequently sought a second opinion from another cardiologist who suggested that he undergo ECP therapy. He agreed due to the non-
4. A 46 year old female, began experiencing recurrent episodes of tightness in her throat that radiated to the left side of her jaw, particularly on exertion (angina CCS class 3). The pain lasted for seven to ten minutes at a time, thereafter completely subsiding. She also experienced shortness of breath whilst walking up a flight of stairs (NYHA grade III). Her blood pressure and heart rate levels were not controlled nor were they within normal parameters. She visited a cardiologist who diagnosed her as having angina symptoms and subsequently referred her for immediate cardiac angiography with view of revascularization. Fearful of the invasive nature of angiography, she decided to try ECP instead. On commencement of treatment, her ECG showed findings of angina. On day 17 of treatment, she managed to walk the distance she did previously, at the same pace, without experiencing any pain. After ECP treatment, she reported having increased levels of energy, which afforded her completion of tasks that she could not previously carry out. Her blood pressure and heart rate levels became more controlled, and were sustained at normal levels. Her ECG finding after treatment was normal. Several months after completion of ECP, She reported that she still had not experienced any episodes of pain or shortness of breath (NYHA grade I), and that her quality of life had improved remarkably.
5. A 49 year old chartered accountant and businessman started experiencing symptoms of coronary artery disease 16 years ago. He subsequently visited his cardiologist, and underwent cardiac angiography. A stent was inserted into one of his coronary vessels and he was placed on medication. Seven years later, he experienced re-
6. A 69 year old gentleman underwent coronary artery bypass surgery 5 years ago, shortly after experiencing a heart attack. He noticed that despite having undergone surgery and being on medical therapy for coronary artery disease and hypertension, he continued to experience symptoms of chest pain and shortness of breath on minimal exertion and while lying flat (NYHA grade II). He took TNT’s at least two to three times per week for the relief of his chest pain (angina CCS class 2 symptoms). He also suffered from non-
7. A 44 year old gentleman suffers from coronary artery disease. He recently started experiencing severe chest pain on minimal exertion, and sometimes at rest (angina CCS class 4), which occurred numerous times on a daily basis. The chest pains required him to take four to five TNT’s a day, in order for the pain to subside. He had three pillow orthopnea (NYHA grade IV). He visited a cardiologist, who referred him immediately for cardiac angiography with view of revascularization. He heard about ECP therapy, and decided to undergo treatment as he wanted to avoid the invasive nature of cardiac angiography. On his first day upon arrival for ECP treatment, he suffered a heart attack and had to be stabilised by the ECP team. On day 8 of treatment, he reported a significant decrease in the occurrence of chest pain (angina CCS class 1) and he was relieved that he could sleep comfortably with 2 pillows at night without having any difficulty in breathing (NYHA grade I). During the latter part of the treatment he was sleeping on one pillow again and reported to be doing much better at work as well. He was glad to be able to continue with his fishing hobby again.
8. A 59 year old male, suffered from coronary artery disease and had three heart attacks thus far. After the last heart attack, he underwent cardiac angiography, which showed triple coronary vessel blockage. He was then immediately booked to undergo a coronary artery bypass graft (CABG). However the only available date at a state hospital was months later. He also suffered from hypertension, non-
9. A 49 year old gentleman, suffers from coronary artery disease, and has had two previous heart attacks. After the last heart attack, he underwent coronary angiography which revealed a double vessel blockage and subsequently underwent a coronary artery bypass procedure four years ago. He also suffers from hypertension and type 2 diabetes mellitus, for which he is on oral medication. He experienced chest pain on exertion. He also suffered from chronic fatigue and generalised body pains. His right ear was also blocked which impaired his hearing levels. He heard about ECP from his boss at work, who decided to send him for the treatment. After four sessions of ECP, he reported having increased energy levels and a marked improvement in his ability to cope with stressful situations that arose from work. His body pains had altogether disappeared. By day seven of treatment, he reported that his ear unblocked after years and his hearing has therefore improved.
10. A 65 year old male, suffers from coronary artery disease. He suffered two previous heart attacks, the last one being just eight months ago. He had recurrent episodes of chest pain (angina CCS class 3) and shortness of breath, even on minimal exertion. He also indicated that he could not walk up a flight of stairs without experiencing significant shortness of breath (NYHA grade III). After the last episode of a heart attack, he was told to continue with his oral medication and he was referred for cardiac angiography with view of revascularization. He also suffers from non-
11. A 45 year old male, is an established coronary artery disease patient, who underwent angiography and had 2 stents inserted subsequently in 2008. He is being managed on medical therapy. He still however experiences chest pain occasionally, at rest (CCS class 4). He also has co-
12. A 58 year old gentleman is a post-
13. A 60 year old established coronary artery disease patient who underwent coronary artery bypass surgery four years ago after experiencing a heart attack. However, he continued to experience symptoms of chest pain, which subsequently resulted in the insertion of 2 stents. He was maintained on medical therapy for his condition, and still continued to experience chest discomfort on maximal exertion (CCS class 2). He also suffers from hypertension, type 2 diabetes and dyslipidaemia, for which he is managed on medical therapy. He decided to undergo ECP in order to improve his health status. After two sessions of ECP, he felt a noticeable change in the duration and quality of his sleep. He no longer awoke at night, and felt refreshed the following day. His chest pain also resolved completely. He also suffered with continuous lower back pain, which altogether disappeared after commencing treatment. His energy levels rose considerably which enabled him to get more tasks done in a day. His overall health has since improved.
14. A 57 year old male, is an established coronary artery disease patient. He has a history of chest pain (CC Class 3), which resulted in him having to undergo an angiogram and subsequently had a stent inserted. Due to the ongoing chest pain, a repeat angiogram a year later revealed no other blockages. He is currently being managed on medical therapy. He also suffers from type 2 diabetes mellitus and dyslipidaemia, for which he is being managed on medical therapy. He concurrently suffers from anxiety, and is on a sedative. He heard about ECP from a friend, and decided to undergo treatment in order to alleviate his symptoms. After 15 treatments, he reported an increase in his energy levels and felt as if he had more vigour. His chest pain subsided. His skin tone also improved. At the end of treatment, he felt an evident transformation in himself and his life and he has gained a sense of wellbeing.
15. A 75 year old male suffered from tiredness which occurred on a continuous basis. He also felt short of breath, particularly on mild exertion (NYHA III). He decided to undergo ECP therapy in an attempt to alleviate his symptoms. After 20 treatments of ECP, he noticed an improvement in breathing, especially when walking long distances. He also felt at ease when climbing stairs and he experienced no sensation of breathlessness (NYHA I).
16. A 65 year old women, is a known coronary artery disease patient. She suffered from chest pains of an angina nature (CCS class 4), on a continuous basis for which she had to take medication for immediate relief. She is also breathless on minimal exertion (NYHA III) and often found climbing up a flight of stairs difficult. An angiogram three months prior to commencing treatment revealed triple vessel blockage, but due to financial constraints in the government sector, she was placed on the waiting list for percutaneous coronary intervention and not a bypass graft. She also suffers from dyslipidaemia, type 2 diabetes mellitus and hypertension, for which she is on medical therapy. She decided to commence ECP treatment in an attempt to alleviate her symptoms. Her energy levels have increased after commencing treatment. She has less frequent episodes of chest pain which now occur on maximal exertion (CCS Class 2). The severity of dyspnoea has improved (NYHA II) ECG changes were also observed with particular improvement in the ST segment.
17. A 56 year old male, is a known coronary artery disease patient. He began experiencing angina pains nine years ago, and subsequently had to undergo a stent insertion. Due to the persistence of his symptoms (i.e. chest pains) he had to undergo coronary artery bypass graft (CABG) surgery a year later. Despite undergoing such procedures and being on maximal medical therapy, he has ongoing chest pains that radiate to his left arm at rest (CCS class 4). He is also an established type 2 diabetic, with co-
18. A 41 year old gentleman with no known illnesses decided to undergo ECP treatment in order to improve his health status and as a prophylactic measure for further illnesses. At the end of the treatment, he reported having increased energy levels which allowed him to carry out more tasks in a day. He was thoroughly impressed with ECP.
19. A 63 year old male, suffered from coronary artery disease and had a stent inserted eighteen years ago. A repeat angiogram in 2010 revealed that he was not a candidate for coronary artery bypass graft procedure (CABG). He was on oral medication. He also suffered from hypertension, non-
20. A 54 year old male, suffered from non-
21. A 56 year old female was a known coronary artery disease patient, who also suffered from hypertension and non-
22. A 68 year old male was a known coronary artery disease patient who underwent coronary artery bypass surgery four years prior. However, he still suffered from symptoms of breathlessness (NYHA III) and chest pain (CCS class 3) which began two years ago. He also suffered from hypertension, non-
23. A 65 year old male suffered from coronary artery disease. He had an angiogram performed in the year 2000 with two stents subsequently inserted. He then had a repeat angiogram done in 2003 with one of the two stents being unsuccessful. He experienced symptoms of slight chest pain radiating to his left arm on mild exertion (angina CCS class 1). He also felt tired after climbing stairs and sometimes after a bath. He suffered from co-
24. A 75 year old male was a known coronary artery disease patient who began experiencing chest pains eight years ago. A subsequent angiogram revealed vessel blockage, with one of two stents being successfully inserted. A repeat angiogram two and a half years ago was performed as he began experiencing severe chest pains. No stents were inserted and no angioplasty was performed. He still experienced chest pain on activities such as walking up stairs or walking up and down his driveway as well as whilst gardening (angina CCS class 3). He had to take TNT on such occasions (usually 2 TNTs per day) and felt relief after five minutes. He also felt breathless whilst walking at a faster pace (NYHA II) and could only walk a distance of a kilometre at a slow pace. He suffered from co-
25. A 72 year old female suffered from coronary artery disease. An angiogram was performed thirteen years ago with two stents being inserted. She experienced breathlessness on exertion and occasionally while asleep (NYHA IV) as well as chest pains on exertion (CCS class II). She suffered from co-
26. A 66 year old male suffered from coronary artery disease. He suffered a heart attack six years ago. He was thereafter managed on oral medication. Recently however, he once again began experiencing chest pain on exertion and at night (angina CCS class 4), which were alleviated with the use of TNTs. His chest pains occurred on a daily basis and thus required the use of TNTs daily. He also felt tired during the day and after certain activities such as showering and walking for short distances. He suffered from co-
27. A 60 year old male was a known coronary artery disease patient who had a coronary artery bypass graft surgery (CABG) ten years ago. A repeat angiogram was performed in 2011 with a stent subsequently inserted. He was managed on oral medical therapy. In 2010, he underwent an aorto-
28. A 60 year old male was a known coronary artery disease patient who underwent a coronary artery bypass graft (CABG) procedure 10 months prior to beginning ECP treatment. Shortly after his bypass procedure, he began experiencing chest pain on exertion (angina CCS class 3), shortness of breath (NYHA III) and tiredness. He could not walk for long distances or walk up stairs without experiencing these symptoms. He also could not drive as he would experience chest pain whilst driving. He visited his cardiologist who performed an ECG stress test that turned out to be positive. He was then referred for a coronary angiogram. However, the coronary angiogram could not be performed as blood tests revealed abnormal renal function. He then decided to undergo ECP in order to alleviate his symptoms and improve his quality of life. On day 17 of treatment, he managed to walk to and from the clinic in his residential area without experiencing chest pain or shortness of breath (NYHA I). As the treatment continued, he noticed that he could walk for a longer distance (1.5km) whilst carrying groceries. He began climbing flights of stairs without experiencing symptoms. He did however experience some tiredness during these activities, but it was not significant enough to precipitate other symptoms or stop the activity. He began driving with ease. He started feeling energetic during the treatment and no longer felt drained and tired. He also no longer suffered from generalised body pains. His fasting glucose levels were maintained around 8mmol/l at the end of treatment.
A 57 year old male was a known coronary artery disease patient. He suffered a myocardial infarction in 2011 and subsequently underwent Coronary Artery Bypass Graft (CABG) surgery. After the surgery, he began exercising daily in the form of walking for 5km and also visited the gym three times weekly. However, eight months after the surgery, he began to feel breathless whilst walking in the evenings (NYHA II) and he could only walk for 1km. A visit to the cardiologist resulted in a stress ECG and echocardiography. The ECG stress test showed no abnormalities but the patient was breathless (no chest pain experienced). Echocardiography showed septal hypokinesis and wall thickening, with an ejection fraction of 65% at rest and 72% during stress. He was referred for ECP by his cardiologist who thought that ECP would aid in alleviating his symptoms. By day 10 of ECP, he reported to have increased energy levels and no longer felt tired during the day. On day 12 of ECP, he was able to walk 2km without becoming short of breath as he did before (NYHA I). After 25 days of ECP treatments he managed to jog without experiencing any symptoms. He also began weight training and planned to return to gym after the completion of ECP.