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Current Postings on This Page (82): I just had a cardiac cath all that was found
was a minor blockage in distal circumflex. I have no pain. was given
test because of arrhythmias, normal echo
also. We all wish there was a pill to remove blockages
in arteries, but there isn't. Statins have shown a small reduction in
some patients, but it's very small. As for the Thallium stress
test -- it's usually used as a pre-angiogram screening test to see if
there are blockages that reduce the blood supply to the heart muscle.
In your
father's case, it sounds like you already know there are, so we're not
sure what new information the Thallium test will show -- and there is
radiation involved in that test. My dad has had 5 Heart Attacks and has also undergone
angioplasty recently which showed blocks of 60% and 75% in the same artery.
Doctor suggested for stent but then he also suggested that we can take
Echo Thallium Test.The other doctor said that these blocks can be medically
(medicines) removed. Plz suggest. Brandy -- did you have a stress test? And did
they do a nuclear stress. This might have shown what is called "a
perfusion deficit" or lack of blood supply to the heart. That together
with the 60% blockage might indicate a clearer course. But you have a number
of symptoms, not all of which are explained by coronary artery disease.
Why do you have home oxygen? Do you have other problems. We assume you
are not a smoker. Hello. I had a heart cath on 9-17, which showed a 60% blockage in
my right artery. I went to a larger hospital for a second opinion. After
looking at the film, they agreed it was about 60%. While I haven't seen the
doc again yet, the nurse told me that this cannot be causing my symptoms.
I am a diabetic, my cholesterol has been fine but my b/p can be up and down.
The first doc put me on Simvastatin and Metoprolol, I'm concerned because
I have shortness of breath upon exertion (I didn't have this 9 months ago),
I can sit here in the AC and sweat like a pig, which is not normal for me.
Additionally, I get chest pains upon exertion or under a lot of stress. I
take the Nitro as directed and it usually helps with one or two pills. Also
have home O2. When delivered the lady did a test that showed the extra O2
helped my HR. I almost sleep around the clock. My legs, feet, arms and hands
can
go dead as I sit here & type & become ice cold with significant leg/ankle swell.
I've read that all of this can be from a blocked artery. I am 33 years old and
had a PE when I was 19. I feel like with all my history and symptoms medicine
is
not enough. Should I get a 3rd op or not worry about it? Thanks. A CIMT (Carotid intima-media thickness) test can
assist with cardiovascular risk prediction. The 75th percentile does not
mean a 75% blockage, but it does indicate that you have "an increased
CIMT", the meaning of which you should discuss with your cardiologist. I just had a CIMT done
and I was in the 75th percentile, does this mean my carotid artery is
75 percent blocked? Nancy -- you posted this under the topic for myocardial
bridging, so we recategorized it to this topic. Are you sure he/she said
a 14% blockage? How was this diagnosed? Normal guidelines are that nothing
below 50% should be ballooned, stented or bypassed. Maybe there's some
missing information?? Ditto to Faye. Also chelation therapy has not been
proven to have benefit, although there is an ongoing trial to see if this
is true. Doctor, I am a 61-yr old female who suffers from
high-blood pressure for 32 yrs, (2008) diagnosed with diabetes, osteo.,
and high cholestrol(all is normal, now, with meds except blood pressure--reason
for CT). I had a CT last month and was advised that I have a 40% blockage
in one artery-the rest are clear. Recently, I have experienced tightening
in my left-upper arm and left-upper thigh followed by a cool sensation
in the thigh. I have also noticed that my memory is not as good as it once
was. I have an appointment with my internal doctor on Friday who said we
would talk about the Ct results. Doctor, according to what I have stated,
what would be your best recommendations for treating me? What do you think
about EDTA chelation therapy oral infusions? I was just diagnosed with 14% blockage of the
LAD and cardiologist wants me to have angiogram and possible stint [stent,
ed.]. Is it common for an angiogram to be prescribed for such a small
blockage? Does size of blockage matter? Whether or not to implant a stent is a complex
decision -- cardiologists try to look at a number of issues: clinical
studies on the outcomes of certain anatomical configurations, etc. -- but
one important
consideration is whether or not the blockage has functional significance:
is it actually limiting blood flow to the heart?. Interestingly enough,
just because one can see a blockage on an angiogram does not mean that
the blockage is impeding blood flow or will be the cause of a heart attack.
Read our coverage of the FAME study, "Better
Outcomes for Stents When Fractional Flow Reserve (FFR) is Used". I have a 50% blockage of the pIV at the back of the heart. One cardiologist
says they will absolutely not stent it and another group at the hospital where
the angioplasty was done recommended it. What is your opinion? J. Reagan -- it's very important to take the proper
medications, especially Plavix and aspirin, post-stenting. Check out our
topic on "Financial Assistance for Plavix
and Other Prescription Drugs"
and some of the information may help you find help. Meanwhile, perhaps
your cardiologist has some samples to tide you over. I am a 54 year old female and had a massive heart
attack Sept 30th, 8 months ago. I had two stents in my LAD and now these
stents are 50-70% narrowed, and I have another blockage in the LAD above
the stents. Am I at risk for another heart attack? Because I have no money
or insurance I take no medications for
this condition. My mom has a heart defect. She has no left coronary
artery and no circumflex artery. She has 4 blocked arteries that are
coming from the Manin right coronary artery. Blockage is 90% on one,
70%, 30%,
and 40%. They say they are too small to unblock. Her heart pills are
not working for her. She can barely do housework. Her heart pills are,
Metoprolol
Tartrate, Ramipril, Lipitor. Is there anyone out there that knows of
how to help her not to have a heart attack and die? The doctors say they
cannot
help her anymore. This is in Canada. Is there any US doctors that know
anything? Please help!!! Her daughter. Ivia -- check out the Forum Topic, "Can
A Total Occlusion Be Stented?" Has he been seen by an interventional
cardiologist who does chronic total occlusions? (a.k.a. a CTO). The
decision NOT to do such a blockage is often because he may have developed
collaterals,
small arteries that provide some circulation and opening a very old
blockage can sometimes do more harm than good. Miami has a number of
excellent
Heart and Vascular Centers, Miami Baptist, etc. My dad is 69 years old has had two heart attacks and two strokes. He has
emphysema and has a feeding tube. His left coronary artery is 100% blocked. Can
anything be done. Two doctors have advised us that nothing can be done. Why is
this? Just came home from the hospital, ekg at Dr.
office did not look good. cardiologist did it again still looked bad.
did angiogram. left coronary artery80% blocked)(LAD and LD was 70% blocked(LCS
30%, LCS a little lower down the LCD was 40% blocked and as you go down
further it branches down and right before the LAD at the bottom and the
the LAD at the top is a artery called LCD which is blocked 50% ad he
LCD
right beside that one was clear. The best he could do was put a Xience
V Everolimus Eluting Coronary Stent System in the 80% LCA CX. I am shorter
of breath now than before but for five days they wanted me to do nothing
so I'm guessing sleeping so much is probably the breathing problem. I
don't go back for one month and its scary not knowing if it stayed in place.
My mother had double bypass at 31 years old at Duke University in Raleigh,
N.C. and my half brother died at 34 of a massive heart attack coming
into
home base. my sister inherited the gene and one other brother got it.
my two children,my daughter no and my son yes he got it. 11 years ago by
angiogram
i was told the main right iliac artery going to my legs was greater than
50% closed but on the right they did not see anything. is it possible
they did not look on the right side and just looked on the left. he said
bypass
would have to fix the rest in a couple of years. how am i suppose to
be feeling with this stent, because i do not feel any better or different
in the pressure or chest arrhythmias Pravin -- the question is "are you symptomatic?".
That is to say, are you having chest pain, angina, etc. that is limiting
your ability to function? The major question is whether to revascularize
(angioplasty
or
bypass surgery) or to stay with OMT (Optimal Medical Therapy) which involves
medications, but also lifestyle changes like exercise, smoking cessation,
etc. Chelation therapy has not been validated although there is an ongoing
trial. But there is no evidence that chelation therapy has any benefit.
EECP is an option if other therapies have not yielded symptomatic relief. I had a CT Scan of coronary arteries and they found 70% + blockage in
LAD Coronary artery. My cardiologist is talking about angioplasty and possible
stent placement. I read about Chelation therapy for the blockage and also EECP
treatment
for this condition and I am confused which treatment I should go for. Jo -- check out our topic on Peripheral
Angioplasty,
since your blockage is in the leg, not the heart. When you say "surgery"
we are not clear -- are you having a surgical procedure or an interventional
(balloon, stent, etc.) procedure? I recently had an angiogram and a blockage of
60% in my right femoral artery. It cannot be stented as it would interfere
with the arterial hinge. What is this surgery called and just exactly what
is done in the procedure. It is not available in my home town and I will
have to go to St. Louis for the surgery. I am a 76 year old female. I have
other stenting, right coronary artery 100% blocked but I have a lot of
collateral veins. I am very concerned about what
my Dr. calls a "complex procedure". What information are you able to give me?
Thanks. Thanks! Just want to thank you for an informative site
that does not go over-board
with ads and advice. MC -- 49% is just below what is considered within
the guidelines for treating (that's 50%). 49% is pretty precise -- how
was this figure arrived at? Did your father have an invasive angiogram??
In any case, we can't give needs to stop smoking. Smoking is a very significant
cause of heart disease. It is certainly hard to stop -- it is, after all,
a physical addiction. But there
are clinics
and support groups around. Perhaps your doctor can help him here with prescription
meds, paches, etc. It is possible that, if he can stop, and lower his other
risk factors, he might not need surgery, angioplasty, etc. -- at least
for now.
See if you can help him. Hello, my father has the choice to have an elective
bypass surgery. The doctor told him he has 49% blockage. He had a stent
put in on the other side
of his heart and has not been the same. They say he will need to choose to
have surgery in the next 3-6 months. He is a big time smoker and is having
a hard
time stopping. Does anyone have any advice if he should choose the surgery
or not? Teri -- have you discussed a CT
angiogram with
your doctor to see non-invasively if there are significant blockages? My name is Teri, I am a 47 y.o woman who had
a 90% blocked LAD in May 07 which in turn caused emergency open heart surgery
on pump in which the Surgeon used a dacron patch after cleaning out the
blockage. 3 mos later below the dacron patch was blocked again below the
patch which in turn a 2nd open heart surgery was done and a bypass using
my mammary artery to bypass the LAD, this was in Aug. 07. I also have several
stenoses(s) on the right side ranging from 50-70% - my concern is this...
I have been having symptoms of chest pain, cough, headaches, low back pain,
heart palps shortness of breath, right shoulder pain, fatigue no appetite
and sharp pain on occasion under my right rib cage. I am constantly stressed
and filled with anxiety "waiting for the other foot to drop" as far as
the other stenosis, my cardiologist just performed a stress treadmill test
and nothing showed anything to concern her at this point, she will continue
my meds and watch the other stenosis(s), I am very un-comfortable and feel
that being as my surgeon told me that my CAD had developed over the past
3 years and I don' quite understand why my cardiologist would not do an
angiogram to rule out any other trouble with the 50-70% blockages. Your
input would be greatly
appreciated. By main trunk, we assume you mean the "left main"?
Left main disease definitely occurs. Stenting a left main has been controversial,
although studies just presented show, in certain cases, that it can yield
a good
result.
Ideally
these
are decisions best made with both your interventional
cardiologist and
a cardiac surgeon, which is what sounds like is happening. Most importantly
is for you all to understand the differences, why a recommendation is being
made for one or another treatment, and what the post-procedural reality
is. Angioplasty and stenting are successful techniques, but so is bypass
surgery -- the key is applying the appropriate therapy for the appropriate
situation. My husband, 51 has been having some light
chest pains. Had a dye test in the cath lab. Doctor said the main trunk
artery is 60% blocked
and the right coronary artery is 80 % blocked. Also, said his heart's pumping
strength is 35%. We are scheduled to meet with another doctor in 2 days
to discuss bypass surgery. A lot of his family have had heart problems.
Doctor said the main trunk artery would be too dangerous to put a stent,
so that is why they are saying bypass. I thought he said it is rare for
the main trunk artery to be blocked. What is your thought. Thank you. Jimmy -- You're welcome. The decision about whether
or not a stent is indicated is definitely something that can only be made
by you and your cardiologist. There are two main considerations.
One, is the blockage causing angina that is not relieved by medication,
lifestyle
changes, etc. (a.k.a. "optimal medical therapy")? Two, is the narrowing
severe enough to be worrisome, for example, will it provide a site for
platelets to collect, form thrombus, and cause an infarct (heart attack).
Much of this decision also rests on the patient's clinical picture -- it's
not just a simple "if it's greater than 70% or 75% we stent" decision.
So we always recommend that you discuss these issues with your cardiologist
--
so you
are prepared
for
and understand
the purpose and reason for whatever
therapy he/she
thinks is best. Thank you for your response,
it was very helpful. We just went to the cardiologist last Friday, he
went through everything
and said the only way to see what is going on is to do a cath. He said
the CT scan is only as good as the reader of it (it was done at a different
facility then he uses). He said that he would like to do a cath to see
what percent the blockage was. We asked at what point does he do a stent,
we would prefer that to be our last resort, we would like to try other
means such as medications and diet changes, are doctors pretty careful
about putting a stent in after a certain percentage. He told us 75% or
more....at that point we would probably want a stent is that correct?
I am more concerned about putting a stent in without having a chance to
try
diet.
Any input would be appreciated. Thank you again. Jimmy -- CT angiograms
are very accurate in ruling out coronary artery disease (CAD)-- a bit
less accurate when showing
positive results, and definitely less accurate when dealing with a calcified
lesion
(the calcium blocks the image). Your question is a very good one and
one that is being debated in the cardiology profession. You have a narrowing,
but can it be managed with medication, diet, exercise, etc? Only your
cardiologist,
who has your records in hand, can really help you make this decision.
The COURAGE trial showed that optimal medical therapy can be very successful
-- it really depends on whether or not the blockage/lesion is significant
(greater than 70%) and if it is flow-limiting. But with modern medications,
it's seems to be fine to start with medical therapy -- it's always possible
to switch over to interventional (angioplasty, etc.) at a later date. I'm a 44 year old male, very physically active not overweight, and a non smoker. I had some slight chest pains and thought it may be due to lack of stretching. I mentioned this to my dr. and he recommended a stress test. The test came back abnormal so they recommended a CT Coronary Arteriogram. The report read that all arteries showed to be normal except the LAD, it demonstrates calcified plaque at the medial portion producing moderate to severe stenosis. This calcified artery plague is identified after the origin of the first diagonal artery. Left Circumflex showed that the origin of it from the left main coronary is normal. The artery is small. The visualized portion of the obtuse marginal are normal. Summary
said: Presence of mild stenosis involving middle third of LAD produced
by a calcified plaque. The left circumflex artery and right corollary
artery fail to demonstrate significant areas of stenosis. Calcium score
is 35
agatston, related to calcified plaque identified at the medial portion
of the LAD. Satisfactory cardiac motion. Ejection fraction corresponds
to 58%. We are scheduled to see a cardiologist this week...the doctor
that did the CT was not very clear...is this the widow maker? Does this
show
what percentage the artery is blocked? At what percentage do they typically
recommend a stent. I would rather try changing my lifestyle and medication
prior to having a stent. My pain is more like tightening in the chest,
but only at rest, when working, I work outside with manuel labor and
never feel it then, nor when exercising. Any questions answered would be
appreciated.
Thanks. R.L.-- Option 1 is really more than "doing nothing".
It may mean no immediate revascularization, but all three options should
really include things your dad needs to do to reduce his risk factors.
Lose
weight, moderate
his
drinking
and
get
on
medications
to reduce his cholesterol, BP, if needed, etc. The automatic grafts you
mention are called collaterals, smaller vessels that the body creates (amazing
bodies we have!) to compensate for some of the blood flow being blocked.
We don't give out medical advice, for example, whether he should fly to
Canada or not. India, of course, has excellent cardiologists who can perform
angioplasty. But these types of decisions should be made together with
an interventional cardiologist and the patient/patient's family, as to
what risk there is, what outcomes can be expected, etc. Obviously you don't
want that 80% blocked Right Coronary Artery (RCA) to progress to further
closure. The doctor told my dad his right artery
is 80% blocked and one of the sub branches is 90% blocked. He said that
the left artery is not
functioning anymore (its been about 6 months to a year and they say he
had a heart attack then - I have no idea how we did not know). He was complaining
about chest pains and said he had trouble walking but thought it was due
to this thighs (this right thigh hurts a lot when her walks). The good
news according to the doctor is that his right artery is very big and pumps
more blood and the heart has automatically made grafts. 3 options were
suggested: 1) Do nothing (we don't favour this one) 2) Angioplasty (the
doctor said it can take care of 80% of this problem) 3) bypass surgery
and do graft (we are against this option) My dad is in india right now
but wanted to travel to canada to get this done. Is it fine to travel?
Also how long can he stall his angioplasty process (he has been stalling
this but we want him to get it done in india next week itself) He is 54,
obese, loves food, non-smoker and drinker. He has been diagnosed with high
cholesterol (of course). Please let me know how dangerous his situation
is and how long can he wait to get this done and also if he should even
travel for the procedure. from a very concerned daughter. Sai -- your Calcium score of 68 is relatively
low. It is one of several risk factors. Family history is certainly
another. Your CT angio isn't as accurate as an invasive angio,
but it's pretty good and a blockage of 30-40% is something to be watched,
but is not in most guidelines recommended for revascularization (angioplasty
or surgery). Do you have any symptoms of CAD? What does your cardiologist
say? Sounds like you are at an early stage, which may or may not progress,
but reducing risk factors is certainly prudent. I'm 32 yrs old. Had a routine 64 slice Ct due
to Family history of heart disease, Father died at 56 from an MI. CT
angio showed a 30-40 percent plaque in mid LAD.Calcium score was 68. What
I do
I do for treatment? Started aspirin,
statin. Please
let me know. ASAP Jav -- angioplasty/stenting is certainly indicated
in a 90% lesion (narrowing) but this may depend on the results of your
other tests as well. What doid the cardiologist who did your angiogram
recommend?? I'm a 55 years old man and i've done coronary
angiography which showed a 90% blockage in RCA. I WANNA ask what should
i do, medication can be beneficial
or angioplasty???? Sandy -- anything under 50% is considered not
significant and interventions, such as stents, are not recommended. The
70% narrowing might be stent-worthy, but the important questions
are: is this 70% narrowing causing a reduced blood flow to the heart?;
is it causing symptoms, such as anginal pain; is it limiting activity?
The
COURAGE trial demonstrated that stable low risk patients can do as well
on "optimal medical therapy" as they can on stents. This means
compliance with medications and lifestyle changes (diet, exercise, smoking
cessation).
If you have questions about the 70% lesion, consult an interventional cardiologist
-- make sure he/she has the angiograms that were done and all other test
results
as well. It is also possible to gauge the progress of coronary artery disease
using other tests, such as a multislice
CT angiogram, which is non-invasive
and takes only a few minutes. Mom had angioplasty done two days ago. Three blockages.
1=20%, 1=30% and 1=70%. The Doctor did not fix this, I heard that hospital
was not licensed for
that procedure. Should she get this 70% done. Which means going through this
procedure again. Concerned Daughter. Please e-mail me back
with an answer. thanks. I have 80% blockage in RCA. Would I need to undergo
Angioplasty
or stenting or can medication cure it? Angela -- most cardiologists recommend trying
optimal medical therapy as a first line to treat angina. This includes
not only medication, but diet, exercise, obviously smoking cessation (but
we would assume that you don't). These were the results of last March's
COURAGE trial. But if that doesn't relieve angina, angioplasty is sometimes
indicated. 50% is considered the borderline for this, but each patient's
clinical situation is different, so this is a discussion you should have
with your interventional cardiologist (the
specialist
who
does angioplasty) and a decision you can jointly make after discussing
the pros and cons. Let us know how things go. I am a now 48 yr old female who had angina in
May of 2001, MI in June of 2001, and CABG in 2003. I returned to the
cardiologist with some slight chest and arm pain, and lot of leg cramps.
A cardiac cath
was performed which shows mid lad 50% blocked. I am already on Plavix,
aspirin and Toprol. What is the
usual treatment for my 50% blockage? Donna C. -- we do not give patients specific diagnostic
advice (and nothing on our site should be a substitute for advice from
a medical professional), but we can say that your various tests put
you in what is called the "indeterminate" category (as if you hadn't
figured that
out
already...).
Nuclear stress tests show whether the heart is getting enough oxygen via
the blood. As you have experienced, they are sometimes inaccurate -- this
seems to occur more in women. A CT Angiogram (CTA) gives a direct view
of the artery, and yours showed a blockage in the indeterminate category.
CTA is an extremely accurate test in ruling out coronary artery disease;
it is still good, but somewhat less accurate in determining blockages in
this mid-range of 40-70% and much of this accuracy depends on the equipment
used and the skill of the intepretation. Have you had a
consult
with
an
interventional
cardiologist (the specialist who does angioplasty)? One question (which
you've correctly raised) is whether or not you should be having nuclear
stress
test followups,
or perhaps a followup CTA or cardiac catheterization at some point. You
don't want to be rushed into a procedure that may not be necessary, but
you also
want
some
peace
of mind. For more about these tests, check out our section on "Imaging
and Diagnosis". I am a 51 year old female. In November my Asthma
Dr. said that my heart was not in rhythm and was skipping beats. I went
to my P.C. Physician the next day and he said it sounded fine to him
and I left. At the end of December, I had severe chest pains which radiated
up to my jaw, down my arm, sweating and then extreme heaviness in my
chest.
EMS was called, blood pressure 186\108 but said that my EKG was fine
and did not transport. They asked me to follow up with my primary physician.
I did and he ran another EKG and it showed that I had a heart attack
on
the left side of my heart. I had a nuclear stress test and nothing showed
up and the cardiologist said I was free to go, my heart was in perfect
condition. However, I was still having pain so requested another test
and my P.C. Physician schedule a 64 slice CT Scan. I got the results last
week
and it showed that my LAD 6, the widow maker artery, was 60% blocked
and one other that branched off of that 40% and on the right side one that
was 35%. Since I was still having pains he gave me nitro spray to take.
He said the Cardiologist said he would follow up once a year with a Thallium
Stress Test. If the stress test didn't show anything wrong the first
time,
why would he perform it again in a year? That was it, no instructions
on diet, what I could and could not do, said I had my 60,000 mile checkup
and see ya. After reading on here from others why they don't do any type
of stents or open heart for anything less than 70%, I understand that
because
of the risk. However, I don't know where this pain is coming from and
some feel like a heart attack is fixing to happen again. I do have high
blood
pressure, asthma and high cholesterol and on Vytorin for that and Toprol
for the high blood pressure. I don't understand why the Cardiologist
hasn't tried to figure out where this pain is coming from or is it just
Angina?
My Granddad died at age 55 of CHF, my Dad at age 55 of CHF and my brother
has
had a heart attack and has CHF, as well as my 29 year old nephew. Paula -- a second bypass surgery and EECP therapy
are the two ends of the therapy spectrum. EECP has been shown to help angina
in some patients. Have you consulted with an interventional cardiologist.
This is the specialist who performs angioplasty and may be able to give
you a prognosis on whether or not he/she can open your blocked artery without
another bypass. These are complex questions that should be discussed with
your cardiologist. I am a 51 yr old female who has a history of a
double bypass 7 years ago. I recently have had frequent angina with SOB
and exertion. A recent coronary
cath revealed a 100% blockage of the RCA. The doctor initially maxed me out
on medication, then suggested bypassing the bypass that is now blocked.
But now
is suggesting EECP. I am confused, what is usually done? And will I eventually
need bypass anyway? I just had a heart cath and have a 50-60% blockage
of the circumflex artery of the left coronary artery; a 40% blockage
of the left coronary artery; a stent in the LAD; and a blockage of 30%
of
the LAD further down below the stent. I also have one more blockage of
the circumflex artery. How does this look for
me? My doctored did angioplasty on LAD having 50
% blockage . I was having the symptoms of uneasiness and minor problems
in the stress thallium test. But since after angioplasty I am having new
problems of pain in left arm and shortness of breath . Can any doctor suggest
the diagnosis. Right cartoid artery 50-69 stenosis,ultasound
mri angiography 50% stenosis. Had 5 way by-pass12-2003,diabetic,high
blood pressure,obesity 58 year old male. I have been treated with aspirin,
plavix,blood
pressure medications and diuretics. Cardilogist recommended continue
with medication. I also was just treated for diastolic dysfunction and
heart
failure. I am having a surgery consultation to learn more about condition. I am a 57y.o. female with a history of 2 TIA's
in June, severe protruding atheromas in the aortic arch, moderate disease
in the descending aorta, and high cholesterol. I was placed on Plavix 75mg,
Lipitor 80mg and 82mg aspirin. I am also under treatment for PMR and am
on a Medrol taper, currently 10mg. I wore an event monitor for a month;
the dx was atrial fibrillation. The cardiologist said nothing further was
indicated, however after a hospitalization which included a cardio consul,
it was strongly advised to have a stress test. The new cardiologist found
abnormalities in the thallium stress test. I had an angiogram , and it
was discovered I had 70% blockage of the LCF, which was repaired with a
DES, and 100% blockage of the RCA. The interventional cardiologist told
me it was too dangerous to try to repair the RCA at that time due to the
amount of dye already used and what would be needed for the second repair,
and I would need to return for the second procedure in a month. He also
told me that there were collateral arteries which had grown off of the
RCA. When I saw my cardiologist the following week, I asked him why I even
needed this second procedure if there were new arteries that had formed.
He told me that the "old way" of thinking was to leave these blockages
alone, but that over the past few years cardiologists had changed their
approach and the proper course of treatment was to open them. The cardio
who did the procedure told me this one would be difficult and long and
he would have to place catheters in both the right and left femoral arteries.
My feeling is of course he wants to do this procedure; it's his job and
it's challenging. However, if it cannot be successfully opened, nothing
further would
be attempted, so is it worth the risks? Michael -- guidelines from the AHA/ACC/SCAI state
that there is little reason to treat blockages below 50% with angioplasty.
Your treatment would most likely be reduction of any risk factors
(smoking, etc.) and other lifestyle changes, along with meds to control
your
disease. But any treatment should be prescribed by your cardiologist!
We're sure
that he/she will also follow up with you in the future to make sure
the blockage hasn't progressed. I have 40% blockage in the left ostium. Please
advise as to treatment. Sharon -- are the 30-45% blocked arteries in the
coronary? Strokes are caused by, among other things, blocked carotid arteries
(sometimes known as neck arteries). A blocked coronary can cause angina,
possibly a heart attack -- although your blockages are below what would
be considered significant. What test showed this blockage? I just found out that my right arteries are 30-45%
blocked. I really worried about strokes. Because both my parents and just
in January of this year my sister died of stroke at age 57. I'm worried
about that will these blocked arteries cause a stroke. I'm age 47. M.L. -- less than 50% blockages are not usually
dilated (opened up with angioplasty) -- but the important fact is not necessarily
the percent blockage, but whether the blockage is "flow-obstructing" or
whether the plaque is what is sometimes referred to as "vulnerable" --
that is, not necessarily a large blockage, but one that contains lipid-rich
material that might rupture, causing a heart attack. Currently, both of
these characteristics can be measured, to some extent, using several procedures
like IVUS or FFR (read about these in our IVUS
Center). If you're concerned about early death due to blockage (which
would be a heart attack) check out the hospitals in your mother's locale
-- find the one that has the best "door-to-balloon" times for
emergency angioplasty. A very important fact lost in much of the news items
is that angioplasty, performed within 90-120 minutes from onset of heart
attack symptoms, can stop the heart attack in its tracks and preserve the
heart muscle. My mom just had an angiogram and they told her
that she had a 50 percent blockage in her main artery and a 30 percent
in another one. My family is prone to early death because of blockage.
What should I tell the Doctor?? Wil -- not taking Plavix and aspirin after implantation
with a drug-eluting stent is definitely not recommended. Just read any
of the many articles on this site -- the main risk factor for late stent
thrombosis is non-compliance with aspirin/Plavix. There is no data to suggest
that aspirin has a negative effect on healing -- it's main function is
to keep platelets from gathering together and forming a clot. And Gary,
50% blockage is a very grey area. Most cardiologists probably would agree
with yours. The question is whether the blockage has a functional effect
-- i.e. is it stopping blood flow, causing ischemia to the heart muscle
or putting you at risk for a heart attack. Each case has to be evaluated
individually. For example, a 50% blockage in a alrge vessel probably isn't
having a great effect, where a 50% blockage in a narrow one might. On 20040410 I had a 100% blockage in the mid LAD
coronary artery. After 3 hours, a drug-eluting stent was placed. For 6
months I have taken aspirin and Plavix. In sept 2004 I felt more and more
out breathing. On 17 nov the cardiologist found a 90% blockage at the edge
of the stent(caused by connective tissue). He placed a second stent in
front of the old one to open it. The cardiologist prescribed again ascal(aspirin)
and Plavix for 6 month. But I had a thought of "Deja Vu" and decided to
take no "medicine" at all. At 5 dec 2005 the cardiologist found both stent
100 % open but I had another blockage 70% in an other branch. He won't
give me a new stent because I had no damage of it (He said) and because
of the trouble I had had with the first stent. I had not agreed I think
that the use of aspirin after stent placing prevents the natural healing
of the arterial wall when it has a little damage by placing a stent. I
think that there is no scientific research about the influence of aspirin
on damaged tissue in the coronary artery. It is even possible that in some
cases the "wonder medicine" Plavix repairs the damage of the use of aspirin.
My cardiologist ( a professor) called me a fantasist. Am I? (ps. I am a
biologist) Jan,06 had 4 stents/right side because of angina,
afterwards everything was great, BP-120/80, great blood work results, lost
weight/great cardio workout. Sept.30, mild heart attack. Another stent
on right side, doctor said that I had 50% blockage on left side. I worry
that I might have inflamed soft vulnerable plaque, and another rupture
could happen. I am 56, in great shape, but worried, my doctor said that
he normally wouldn't do a stent on the 50% blockage, said it is up to me,
would do you suggest, thanks Pratul -- wow! Climbing in the Himalayas with
a 100% blockage in the Right Coronary Artery? Either the tests are from
the man down the hallway, or your left coronary arteries are in great shape.
You did say that, and it's true that some people have a very dominant left
or right system, which must be the case here. A 100% blockage is also called
a Chronic Total Occlusion (CTO) if you have had it for some time. How best
(or even if) to open these vessels is a big topic in interventional cardiology
right now and the subject of many presentations and discussions at the
major heart meetings. There also are new devices on the market, specifically
designed for these cases. There are many technical challenges with CTOs
-- not the least of which is that, since the contrast dye can't pass through
the blockage, it's hard for the cardiologist to see where to safely push
the guide wire for the balloon. A wrong turn and he's dissected the artery
wall. Think of driving your automobile through a tunnel while blindfolded.
As for reversing coronary artery disease, Dean Ornish has indeed published
studies showing a small reversal in arterial plaque under his diet, exercise
and meditation plan. At the last American College of Cardiology meeting,
Steve Nissen MD of Cleveland Clinic also showed a study in which heavy
statin dosages reversed plaque. But these are just the beginnings and the
reversals are not massive -- but they do show a direction for more research.
As for your CTO, you might want to consult with interventional cardiologists,
as well as surgeons, who are experienced in doing total
occlusions (practice makes perfect) and get their opinions before making
a decision. I am 44 yrs old and had a positive stress test
a year and a half ago for an insurance policy that I had to take. A second
stress test was taken in feb'06 which was also positive. A coronary angiogram
was done on 2nd Sep where it was found that there is a 100% block in the
RCA while the two left arteries were completely open. I am advised angioplasty.
After the angiogram I have done a 40 km trek in the Himalayas at 10000
ft height up to 14600 ft (stayed overnight at this height) over 4 days
and did not feel much discomfort. I have been doing yoga and pranayam for
the last 7 yrs and intermittent walking (average of 2-3 days in a week
). I have just purchased the book of Dean Ornish on reversal of heart diseases
and wonder if this is really possible, since my doctor says reversal is
impossible and that Angioplasty is the only remedy for opening the blockage.
And that at best such alternative therapies can only stall the blockage.
My question is Can Angioplasty be done on fully blocked arteries ? If so,
how long can I wait before I do the angioplasty ? Is it a fact that after
a certain period lapses say 6-12 months, Angioplasty may not be doable
and the option left would be only a bypass ? I wish to explore alternatives
without jeopardizing my chances of getting the Angioplasty done ? I am
ready to adopt lifestyle changes as suggested. Please suggest /. advise
course of action. Ian
from Chicago - read the excellent response from the editor. You only
need a stent in the RCA if you have SYMPTOMS of angina NOT controlled
by medication. putting a stent in will not make you live longer and not
reduce risk of future cardiac events (it may actually increase those
risks!) Jack, 50-60% is not necessarily "obstructive",
but given your concern, you're doing the right things. We would add to
check your blood pressure and cholesterol levels on a regular basis and
treat any abnormal findings. But exercising, diet and not smoking are key
factors. We just attended a Heart Health Symposium presented by cardiologists
at New York's Cornell Medical Center and they were emphasizing that family
history is not really as great of a risk factor as is,
for example, smoking, etc., because the genetic or environmental tendency
towards the other risk factors can be controlled, as you are doing naturally
by "being healthy", and, if there is high blood pressure, etc.,
thoses factors can also be controlled through modern pharmaceuticals. My brother died at 38 years old not from heart
disease. The autopsy reported a couple of his arteries were 50-60% blocked.
I am his brother 5 years younger and am concerned. Two questions: is 38
male common or uncommon to have 50-60% blockage it seems young. And, besides
diet, exercise, and not smoking, is there anything I should do to prevent
this from happening to me? Thanks, Ray. I suspect it's an individual judgment call, Terry.
I had a ~50% blockage in the CX artery and my cardiologist chose to stent
it. Like the forum editor noted, the fact your RCA was 100& blocked sounds
like the reason. Because a 50-60% lesion without haziness on the
angiogram is not flow-limiting. Sometimes a lesion that is only 30% is
significantly hazy on the angiogram and it indicates soft plaque and can
be stented. The other thing to remember is stenting treats angina; it doesn't
prolong your life. If you have a lesion that does not appear to limit blood
flow, then why stent it? If something goes wrong during the procedure,
your life could end in a matter of a few minutes while on the table, and
there was no obvious indication to stent the lesion to begin with. Carol -- as we mentioned below, there are guidelines
reached by the major professional organizations. You can read the most
recent update of this document, titled "ACC/AHA/SCAI
2005 Guideline Update for Percutaneous Coronary Intervention—Summary Article" in
PDF format. It's 20 pages (and that's just the summary) and relatively
complicated for a lay audience. Suffice it to say that the decision as
to what should be treated by revascularizing (i.e. angioplasty with or
without stenting, or bypass surgery) and what should be treated with medications
and lifestyle changes really depends on the specific clinical situation.
It's not a hard and fast "this artery is 70%, so open it -- this one
is 65%, so leave it alone". It depends of the state of the other coronary
arteries, the patient's clinical situation and other health factors. It's
a complex question. The new guidelines actually outline circumstances where
a 50% stenosis might be dilated -- and actually they don't state categorically
that anything under 70% should be left alone (we amend our previous post)
-- because they are allowing cardiologists the leeway to make those judgements. Is there any one place which sets out the guidelines
regarding the size at which an artery should be surgically opened and when
they should be treated with medication? Is there some AMA standard, or
is it set more by insurance companies, or the local hospital. I've heard
different sizes by different cardiologists, but each claims that "standards" require_____
size. Who are we to believe? The subject of why cardiologists tend not to dilate (open up) and stent arteries less than 70% is understandably a tense one for patients. The patient sees the angiogram, sees the blockage, but their doctor doesn't want to treat them with a stent. We'll talk about that, but first off, a quick disclaimer: as we always state, do not take anything on this site as "medical advice" -- we try to provide information to help you talk more productively and efficiently with your doctor. One patient's clinical situation can be very different from another's, and lead to very different therapies for seemingly similar problems. As we say on our page about coronary artery disease, "Angioplasty and bypass are mechanical 'fixes' to what is essentially a biological problem." And they are the most invasive fixes -- hence the guidelines from the AHA/ACC not to treat blockages < 70%. As with all medical procedures, there are risk factors associated with each type of intervention. Through the creation of evidence-based "best practice guidelines", professional organizations like the American College of Cardiology (ACC), Society for Cardiovascular Angiography and Interventions (SCAI) and the American Heart Association (AHA) have determined various thresholds for treatment. It's not so much that the patient isn't eligible below the threshold, but that the treatment just doesn't do all that much, and is not worth the risk, even if that risk is small. In other words, instead of regretting that you can't be stented because your blockage isn't big enough, it's actually good news: it's not big enough! There are other treatments -- there are a range of pharmaceuticals that can mediate symptoms and, as recently shown at this year's ACC meeting, statins can actually reverse plaque build-up. Lifestyle changes (smoking, diet, etc.) are all critical. Dr. Dean Ornish has shown reversal of symptoms of coronary artery disease (and even some lessening of plaque) through his program of diet, meditation, etc. Obviously, any blockage is a sign that you need to be monitored over time -- there are newer less-invasive tests, like multislice CT angiography that can make this easy and quick. Finally, because we are all so visually-oriented, we may put too much emphasis on the appearance of the blockage on a two-dimensional angiogram. But what is the actual effect of that blockage? So-called "functional tests", like Thallium Stress Tests, can measure if these blockages are actually reducing blood/oxygen to the heart muscle -- they may not be. Also there is much research being done right now that seems to indicate some plaques are more "vulnerable" than others -- more prone to rupturing and sending lipids into the bloodstream, causing thrombus (clot) and a heart attack. It may not be the size of the plaque, but the tissue characteristics, that are important. So getting the news that you have a blockage that's too
small to stent unless it gets bigger means you have other options. And
that's good news. I understand this
is an old topic, date-wise that is, but my questions fall under its category
and I guess I'm just reaching out for some answers tonight. I'm a 28
year old male who recently had stent put in due to 100% blockage of the
LCA. Not to point out the obvious but 28 is rather young. Having said
that and confirming that the age is not a typo I feel I should give you
quick background about myself so you can hopefully help me to the best
of your abilities...The stats; 5'10"...180 pounds...smoker, was for about
a decade, athletic, and truth be told I love things like pizza and wings
as most do, but I don't think I ever indulged more than any one else
my age. Family history...Lots of heart attacks on both sides. Now that
we've covered the history I'm concerned about the future. I have questions....While
I understand you can't give medical advice hopefully you can help to
point me in the right direction. My RCA is now 60% blocked. My cardiologist
doesn't think it's time to do a second stent. I understand we only use
roughly 30-40% of our arteries capacity but why wait? How many opinions
should I get? I guess I'm a little, well concerned would be understatement,
but I just want to be able to live my life and not worry that every time
my heart rate every time it gets elevated. I want the peace of mind that
both arteries are up and ready to go. My friends and I still play basketball
and volleyball and football and drunken whiffleball, it's a good game....
I just want to know, as much as possible at least, what the future holds.
I've asked my doctors point blank before and they seem to dance around
the issue with reassurances. I don't want it to seem like I'm looking
for the worst case answers, but in a sense I want to know. I need to
know what the stats are. How long will this stent last? 20 years may
be great for someone in their 50's, but where does that leave me? I know
I've thrown a lot out there, thank you for your time. I'm a 56 year old female with a high stress
job as a clinical psychotherapist. I also just had a 100% blocked right
coronary artery which received the Taxus Express -Paclitaxel-Eluting
Coronary Stent system. The left LCA was 60% blocked and the doctor stated
the artery was "too narrow" to operate on right now and that they won't
work with it until it is also 75% blocked. He stated there's too much
of a chance that if "something goes wrong with the one procedure, it's
too easy to have the other artery crash as well." I was wondering if
I should see someone else, but after all the emails I read I guess this
is common. I also do not feel "great" like many people state after the
procedure. I don't have a new burst of energy, still have trouble with
breathing. I'm not sure I'm satisfied with his response. Anyone else
have info on this post-procedure lethargy and anxiety about the other
artery? hi i got my ct angiogram and has shown 49%
blockage. my doc says that i must go for angiogram because the blockage
may be up to 80% and then they will decide about angioplasty .. i need
your advice..do i need this to be done or it can be cured by changing
life style and medicines..he has advised me statin and aspirin 150mg Hi all. Was diagnosed with Coronary artery
disease via Angiogram done in Dec last. I have had AF (Chronic) for 6
years now, I am now 56 yr old male. Just had the Angioplasty to fix just
one of the arteries (80% blocked). although I was told that the other
2 of them were around 50% blocked. I have been fitted with an approved
stent as far as Europe is concerned but not approved by FDA. It's a bifurcation
stent to fix a branch and front descending artery. Operation was OK,
now on Plavix, Aspirin, Warfarin (AF) as well as sotalol for the AF and
cozaar for high BP. Also need to get some Cholesterol lowering drug but
Pravastatin brings me out in hives (not pleasant). I too have been given
no indication of what or how I should try to get fitter, although this
was always a prob due to the AF stopping me (of course it may have been
the blocked arteries as well). Why would they not have stented the other
2 while they were in there? Any ideas? Tom, as for exercise and your doctor's recommendation
not to do any for a month, we always recommend following your cardiologist's
recommendation, as long as you discussed this with him/her and have gotten
answers to your questions. If there is something you don't understand as
to "why", you should ask about it. It helps you as a patient
to know. As to the other arteries at 60-70%, again without knowing your
clinical info and seeing the angiogram, no one can make a recommendation,
but most guidelines don't recommend doing angioplasty on less than blockages < 70%
-- these usually can be managed with lifestyle changes and medications. Last week I did my angioplasty and found a 95%
blockage in one of my major arteries and that has been addressed with a
Cypher Stent. The doctor also informed me that I had 60-70% blockages in
my other two arteries but advised against any stent or plasty operation.
Is this usual? He also advised I should not do any exercise for one month
and I wonder how sticky this rule is? Terry, more important than why you haven't gotten
an angioplasty or another drug-eluting stent is, "are you adequately managed
medically?" There are large trials which show that aggressive medical therapy
can have less complication and deaths long tern than either open heart
bypass or cath lab stents, ...it's just that interventional cardiologists
are one of the few groups of docs in the US who can "self-refer". This
is their income. In other countries such as the UK, cardiologists manage
their patients health and prevention, and if they have to refer their patient
to a cath, the patient goes to the center where the doctor does the test,
then their daily cardiologist is consulted on what's right for the patient
long term prior to rushing to do another procedure to them. Did he get
your LDL cholesterol below 70? Does he keep your BP below 130/70? Does
he control your blood sugar if you're a diabetic? Please make sure you
don't smoke, you watch that diet, you need to insist on a "statin" drug
even if your cholesterol is normal, and you need other meds such as beta-blockers
and ACE inhibitors, daily aspirin....etc. The guidelines are in the AHA
and ACC web sites. We all have responsibility as patients to follow all
our physicians advice and quit relying on implants like stents to "forgive
our sins". Thanks I forgot to mention that the middle artery
was stented about 2.5 years ago. Anyway on lots of medicine. Thanks again.
Terry Terry -- there are a number of reasons why your
cardiologist might not want to open the 50-60% blockage. The fact that
your Right Coronary Artery (RCA) is 100% blocked is one of them. Should
something go wrong during the angioplasty of the "widow maker" (the
Left Anterior Descending or LAD artery) you'd be left with neither artery
functioning. Also it usually is not recommended to do angioplasty on a
blockage less than 70% -- the risks of any intervention, while small, outweigh
the benefits. Moreover, even with a 50% blockage, a significant amount
of blood still flows through the artery to the heart. Yours is a tricky,
or complex, situation. Ideally it would be interesting to try and open
up the totally occluded right. Technology for doing this is improving every
day. We assume that you're on a number of medications, like blood-thinners
-- certainly aspirin -- that also give you some insurance against blockage.
When you questioned your cardiologist, did he/she give you any reasons
why angioplasty needed to wait? I had a light heart attack 10 years ago, cardiac
ablation 5 years ago, I have the right coronary artery blocked 100%, and
the widow maker at the last angio 50 to 60% blocked. My doctor tells me
they will not open the 50 to 60% artery until it exceeds 75%. Why is this?
wouldn't it help to open any blockage when you have one totally blocked?
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