Metabolic approach to ischemic heart disease in the elderly

A 79-year-old hypertensive, diabetic woman with known ischemic heart disease, previously revascularized, was referred to our Cardiology Department because of effort-induced dyspnoea associated with bilateral calf stiffness during a walk at high altitude. A thallium scan with intravenous (i.v.) dipyridamole stress showed a fixed inferior perfusion defect and a reversible perfusion defect in the posterior and lateral wall. Medical therapy was optimized before undergoing further interventional procedures. Antihypertensive medications were optimized and anti-anginal therapy implemented with trimetazidine. The patient also began a cardiac rehabilitation program. After 2 weeks, dyspnoea with effort disappeared, and after 3 months her exercise capacity improved by 50%.