Alter Ego(s) in Coronary Artery Disease: Insights From a Recently Departed Patient

Franz H. Messerli, MD; Adrian W. Messerli, MD

Disclosures

Eur Heart J. 2018;39(45):3987-3998. 

In This Article

Presentation of Case

'Ever since the family doctor, during a routine check-up, discovered an abnormality on his EKG and he went in overnight for the coronary catheterization that revealed the dimensions of the disease. Henry's condition had been successfully treated with drugs, enabling him to work and to carry on his life at home exactly as before. He didn't even complain of chest pain or of the breathlessness that his doctor might well have expected to find in a patient with advanced arterial obstruction. He was asymptomatic before the routine examination that revealed the abnormality and remained that way during the year before he decided on surgery—without symptoms but for a single terrible side effect from the very medication that stabilized his condition and substantially reduced the risk of a heart attack.

The trouble began after 2 weeks on the drug. 'I've heard this a thousand times', the cardiologist said when Henry telephoned to report what was happening to him. The cardiologist, like Henry a successful, vigorous professional man not yet into his 40s, couldn't have been more sympathetic. He would try to reduce the dose to a point where the medicine, a beta-blocker, continued to control the coronary disease and to blunt the hypertension without interfering with Henry's sexual function. Through a fine-tuning of the medication, he said, you could sometimes achieve 'a compromise'.

They experimented for 6 months, first with the dosage and, when that didn't work, with other brands of the drug, but nothing helped: he no longer awakened with his morning erection or had sufficient potency for intercourse with his wife, Carol, or with his assistant, Wendy, who was sure that it was she, and not the medication that was responsible for this startling change.

He returned to the doctor to have a serious talk about surgery. The cardiologist had heard that a thousand times too. Patiently, he explained that they did not like to operate on people who were asymptomatic and in whom the disease showed every sign of being stabilized by medication. If Henry did finally choose the surgical option, he wouldn't be the first patient to find that preferable to an indefinite number of years of sexual inactivity; nonetheless, the doctor strongly advised him to wait and see how the passage of time affected his 'adjustment'. Though Henry wasn't the worst candidate for bypass surgery, the location of the grafts he'd need didn't make him the ideal candidate either. 'What does that mean?' Henry asked. 'It means that this operation is no picnic in the best of circumstances, and yours aren't the best. We even lose people, Henry. Live with it'.[1]

Multi-choice Question: What was the Outcome of the Above Case?

  1. Henry decided to 'live with it'.

  2. Henry had coronary artery bypass grafting (CABG) and resumed sexual activity.

  3. Henry discontinued the beta-blocker on his own and stopped seeing his cardiologist.

  4. Henry had CABG and remained impotent.

  5. Henry had CABG and did not come off the table

Answer to question towards the end of article.

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