### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
My brother, who is 61 yr old, recently became feeling very faigued at the end of the day and had developed a cough. He went to dr and had chest x-ray. It was noted that he had some enlargement of his heart on one side and he was referred for ECHO, cath, etc. It was found his main artery in his heart had 100% blockage and his heart was only operating at 15%..he had evidently had a massive heart attack some time and didn t even know it. His cardiologist did not feel he was a candidate for surgery, as the risk would be too great. He only offered a defibrillator and pacemaker and Plavix. Would you feel a second opinion at a thoracic surgeon would be in order? Would a no-pump by pass be possible?

### output:

Hello and thanks for writing. I can understand your concern and would try to help you in the best possible way. Your cardiologist is right that any procedure would be more damaging to your brother as his heart is functioning at a very low level. As far as surgery is concerned his low EF already makes him a very high risk candidate for surgery. He has correctly advised you for an ICD as the major threat to his life is an arrhythmia that tends to occur more with weak hearts. This would be taken care of by ICD. He has also put him on anti platelets that would prevent any further heart attacks. You have to understand that your brother now requires utmost care and various lifestyle modifications including:1. Total fluid intake should not exceed 1.2 L per day.2. His urine output should be aerial to his fluid intake to prevent any fluid from collecting in the body.3. He should restrict his salt intake to less than 2300 mg per day.4. He should have a low fat low salt diet. Consult a dietician for a detailed diet plan.5. He should restrict his activity and avoid strenuous work. But that does not mean that he should be confined to bed. He can take regular walks and other light exercises. You may consult a CTVS surgeon and consult regarding the possibility of a surgery.