Experts say medical report ‘inconclusive’

Published: January 8, 2014
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Aside from an assessment of Musharraf’s heart condition, the report also states that the former general had recurrent discomfort in his left shoulder joint, as well as pain and stiffness in the lower back. PHOTO: REUTERS/FILE

Aside from an assessment of Musharraf’s heart condition, the report also states that the former general had recurrent discomfort in his left shoulder joint, as well as pain and stiffness in the lower back. PHOTO: REUTERS/FILE

ISLAMABAD / KARACHI: 

When the ‘confidential’ medical report of the hospitalised former president, General (retd) Pervez Musharraf, was made available to the media, reporters scrambled to decipher the medical jargon in a rush to determine the status of the former military ruler’s health as assessed by the Armed Forces Institute of Cardiology.

“The calcium score in his arteries indicate blockages, but this report is not conclusive. A proper, invasive angiography would clarify the extent of the disease,” a cardiology consultant told The Express Tribune, adding that the former president may have critical blockages.

“If the angiogram confirms that he has severe narrowing in the left main/proximal LAD artery, then this could certainly lead to a fatal heart attack,” he said.

Nine specific ailments were mentioned in the report.

Musharraf’s medical report is divided into five categories, namely, case history, initial examination, emergency treatment, investigations and progress and, finally, the diagnoses.

While experts say that the initial exam revealed normal blood pressure and a slightly low pulse, the ECG was “normal” and did not suggest that Musharraf had suffered a heart attack.

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The detailed investigation in the report puts Musharraf’s diagnosis as “densely calcific Triple Vessel Coronary Artery Disease including left main stem disease,” which the doctor said indicates a “moderate, not mild narrowing of arteries”.

His cholesterol is also slightly high and requires treatment, the doctor said, considering that the report suggests he is a smoker and has a family history of coronary disease.

“This report doesn’t mean he will have a heart attack tomorrow. But it also doesn’t confirm critical blockages. It simply confirms that vessels are narrowing.”

“In my experience, this preliminary report suggests that Musharraf may need a bypass.”

Aside from an assessment of Musharraf’s heart condition, the report also states that the former general had recurrent discomfort in his left shoulder joint, as well as pain and stiffness in the lower back. His sleep was disturbed because of an enlarged prostate. He had a root canal and crowning two weeks before admission to the hospital, and had developed pain in his jaw that was still persisting.

Dissenting view

“This could be the report of any 70-year-old army man,” one leading heart surgeon told The Express Tribune, upon examining the report. “He has not had a heart attack. The symptoms as described in this report are not pointing towards an attack. His pulse is a bit slow, but his blood pressure is normal.”

The doctor, on request of anonymity, said that the condition could be compared to the plumbing in an old house. “There may be blockages. But the tap water is still flowing,” he said, expanding on the analogy. “If he wants to avoid a heart attack, he has to get a further exam to look at spots where there is acute narrowing.”

The doctor also said that previous medical reports are essential, as they will show how Musharraf’s condition has deteriorated in the past few years.

Heart’s secrets revealed

Echocardiography revealed normal sized cardiac chambers, no segmented wall motion abnormality, good left ventricular systolic function with ejection fraction of 60%, grade 1 diastolic dysfunction and normal heart valves.

24 hours Holter electrocardiography revealed heart rate ranging from 49 to 97 beats per minute and ventricular premature beats

He had raised serum total cholesterol (218mg/dl) and LDL cholesterol (150mg/dl). Other laboratory investigations including serial cardiac enzymes, blood sugar, serum urea, creatinine, sodium, potassium, prostate specific antingen, bilirubin, ALT and uric acid were within normal limits

Multislice CT angiography revealed densely calcific Triple Vessel Coronary Artery Disease including left main stem disease (calcium score: total 851.3; left main stem (LMS) 20.6, left anterior descending coronary artery (LAD) 499.9, left circumflex coronary artery (LCX) 239.6, right coronary artery.

Diagnosis reveals that he has densely calific Triple Vessel Coronary Artery Disease including left main stem disease.

He is also found to be suffering from hypercholesterolaemia, cervical spondylosis, lumbosacral spondylosis, biceps tendinitis, frozen shoulder (left), osteroarthrosis with effusion (left knee joint), temporomandibular arthralgia (left), benign prostatic hyperplasia

A coronary angiography is required to optimise the management and to ascertain the possibility of further interventions like coronary artery bypass surgery.

SOURCE: COMMANDANT AND EXECUTIVE DIRECTOR AFIC

Published in The Express Tribune, January 8th, 2014.

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Reader Comments (14)

  • Ricky
    Jan 8, 2014 - 3:00AM

    “This report doesn’t mean he will have a heart attack tomorrow. But it also doesn’t confirm critical blockages. It simply confirms that vessels are narrowing.”
    Every person’s arteries start narrowing down very slowly since adulthood. It is a slow process and the CT for calcium is a crude and old test. The gold standard is angiography to give the true picture of blockages if any. Narrowing is a natural and ongoing process but high % of blockages is dangerous and requires immediate surgery. Mush’s EKG shows no heart episode and there is no immediate danger. In fact he at 70 years is in much better shape than most 60 years old Pakistanis. This man has once again surrendered when it came to facing the music. Mush is setting a great example of bravery by a commando. When Mubarak can be brought to the court why not Mush?

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  • Mirza
    Jan 8, 2014 - 3:05AM

    A dictator in power Mush used to be a real tough guy against Pakistani civilian leaders. Now he has no arms and no power look how he is behaving? He is in great shape and there is no immediate threat to his life. All this drama is to run away and never look back. His wife has already left (means his health is fine) Pakistan instead of being with him and he is looking for ways to join her. Mush has been a real brave commando when the US threatened him, at Kargil and now when he does not have dictatorial powers he is hibernating.

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  • AnisAqeel
    Jan 8, 2014 - 4:50AM

    He bears all the signs of a healthy 60 plus except for the arteries mentioned that can be repaired/unclogged (if any???) in a couple of hours and can be easily performed in Pakistan.
    Prostate enlarges, back pain, shoulder freeze or tooth aches are obvious, root canal and crowns are luxury not danger to life and his blood pressure at 120/80 is excellent if not better than excellent. He is making fool of the entire nation that bears high rate of uneducated and can be convinced. My guess, his physical age may be around 55-60 than actual age of 70.

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  • Imran
    Jan 8, 2014 - 5:15AM

    Get well soon Hero!! All these opponents have no idea that Pakistan is here ONLY because Musharraf ruled it !

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  • Insaan
    Jan 8, 2014 - 5:36AM

    Why did Musharraf go to the hospital in the first place? Most of his results are normal. Nothing seems to be life threatening.

    He can get tested more and still go to the court.

    His illegal action in Kargil killed 1000s of soldiers for nothing. He even did not tell the truth about Kargil to Pakistanis and refused to take dead bodies of Pakistani soldiers killed in action.

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  • polpot
    Jan 8, 2014 - 5:53AM

    Experts say medical report ‘inconclusive’”
    +++++++++++++++++++++++++++++++
    The only conclusion that may be drawn is that the accused is 100% capable of attending a court session and being indicted.
    Subsequent treatment may be carried out in the prison if successfully prosecuted.

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  • C. Nandkishore
    Jan 8, 2014 - 6:22AM

    Here is, what I think, is a layman’s guide to heart attack:
    1. When there is a pain / burning in your chest even for a part of a second and you have a swooning feeling even for a second see the doctor immediately.
    2. When there is a pain / burning in your chest even for a part of a second and you have a sweating on your scalp even for a second see the doctor immediately.
    3. ECG is indicative, not conclusive of not being prone to heart attack.
    4. 2D echo – Mush has a ejection factor of 60%. I presume it means that 60% of the blood that is there in the chamber is ejected. Lesser the factor means that blood is not flowing to the heart muscles.
    5. TMT – Thread Mill Test – Minus your age from 220. lets call it X. While undergoing a TMT your blood pressure should raise to this number X. Otherwise the heart is not getting full blood flow. A good indicator.
    6. If you want to be very sure, then angiography.
    My advise? If you have even an iota of doubt go for angiography. Its very safe. It tells you the truth, as it is at that moment. Its your life. Even if the doctor advises against it.

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  • Jim
    Jan 8, 2014 - 6:27AM

    Please send him to India like you send 100s of your people for treatment. We will take care of him:).

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  • justice
    Jan 8, 2014 - 6:57AM

    Justice should be made no matter if heaven falls. Why can not a military dictator brought to justice? Aides should also be trialled and do not let them blackmail the system.

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  • Ajab Khan Baloch
    Jan 8, 2014 - 8:01AM

    I am ashamed of Musharaf,.What a coward.And the medical report: I am disappointed at what has been stated.I thought he went to the AFIC because he suffered a near heart attack not because he had frozen shoulder or pain in his knees. For someone who is 70 and who smokes liquid total cholesterol (218mg/dl) should be not worrying. Musharaf should be brave and face the high treason trial

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  • Assad
    Jan 8, 2014 - 9:53AM

    @Insaan:
    The Pakistani troops died for Pakistan and Kashmir at Kargil and not for Musharraf!! Get that through your head.

    Pakistan was not going to take the dead bodies of our troops under the glare of the Indian media which is what they wanted so they could use that for the propaganda purposes against Pakistan.

    Those who made the ultimate sacrifice are our heroes regardless of their bodies being received or not. They are not any different than those other heroes who gave their lives for Pakistan at Siachen, and during the 1971, 65 and 48 wars.

    We have countless officers and jawans who were lost at Siachen with their bodies still on the frozen glacier. This is what they have done for us and we are eternally grateful to them.

    There was nothing illegal about Kargil. It was part of Pakistan until you Indians took it over in 1971. The town lies across the LoC which is not the IB so there is nothing illegal about Pakistan wanting to adjust the LoC to its advantage. You Indians have done it all along.

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  • saeed minhas
    Jan 8, 2014 - 10:01AM

    Treason trials is no doubt a national issue and should be dealt on priority basis but , Musharaf’s sudden heart breakdown, rushing to MH , prolonged stay in AFIC and recommendations from abroad are no more secret now and have been part of our country’s power history- a history of a typical third world country where so many power players do such tricks .so many times it happened in our country that power broker play such games and public is be fooled reading the stories and discussing and proving who is hero. Musharaf ,Govt , Judiciary. in fact they are all players playing for their personal gains and remember there are some superstar playing above them some are US ,some others are Saudis and now some more are Turkish- dictating them how to play and we the people clapping around- no doubt it should be decided once for all who is right or wrong but sorry to say public has earlier spent 5 years waiting for outcome of NRO but at the end some learned law expert could not satisfy the poor people. I just ask one question will judiciary take up matters relating to public interest with same speed as it does in the cases of elite class. We hope a speedy justice this time.

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  • Rex Minor
    Jan 8, 2014 - 5:07PM

    There is no doubt that Pakistani medics do not have the most modern equipment to detect the heart attack in a patient, nor of any blockage without undertaking the invasive angiography. Mr Parvez Musharaf is obviously on drugs to control his blood pressure as well as to cure the so called benign conditions of his prostrate. He must have a second medical checkup after 48 hours to ensure that he does not have the virus infection of Herpes Zoster which causes similar conditions to that of angina pectrus.

    Rex Minor

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  • saeed minhas
    Jan 9, 2014 - 9:04AM

    Every one who sacrificed his life for the country is a martyr, we all agree but who is gona pay the price after Kargil when India turned the tables against Pakistan . we suffered a lot and still suffering . economy on the knees , no foreign investment , even no foreign visitor . will some 1 ask Mr. Musharraf why did you all alone decided the Kargil adventure without the approval of the then Govt. knowing that no one will defend the case on diplomatic fronts . Nawaz Sharif tried his level best to cool down the situation which he eventually did but Pakistan had suffered a lot all because of the adventurous instinct of Gen Musharraf . as far as Kargil being part of Pakistan why did Pakistan not retaliated at that time. I personally believe Kargil adventure was a part of the conspiracy against Pakistan and against armed forces to put Pakistan on back foot. Rest of the story is still in progress@Assad:

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