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Current Postings on This Page (44):
• 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??
Forum Editor, Angioplasty.Org, April 27, 2008
• 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????
Jav, Pakistan, April 22, 2008
• 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.
Forum Editor, Angioplasty.Org, April 21, 2008
• 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.
Sandy P., New Jersey, USA, April 9, 2008
• I have 80% blockage in RCA. Would I need to undergo
Angioplasty
or stenting or can medication cure it?
Pankaj, India, February 15, 2008
• 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.
Forum Editor, Angioplasty.Org, February 13, 2008
• 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?
Angela B., Indiana, USA, February 7, 2008
• 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".
Forum Editor, Angioplasty.Org, February 7, 2008
• 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.
Donna C., Isle of Palms, South Carolina, USA, February 4, 2008
• 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.
Forum Editor, Angioplasty.Org, February 4, 2008
• 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?
Paula, Madera, California, USA, January 11, 2008
• 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?
Donna S, Baltimore, Maryland, USA, December 22, 2007
• 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.
Sunsing, India, October 5, 2007
• 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.
FJV, West Virginia, USA, October 2, 2007
• 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?
Lynda A., New York, USA, August 25, 2007
• 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.
Forum Editor, Angioplasty.Org, August 10, 2007
• I have 40% blockage in the left ostium. Please
advise as to treatment.
Michael P., North Carolina, USA, August 1, 2007
• 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?
Forum Editor, Angioplasty.Org, July 22, 2007
• 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.
Sharon S., New York, USA, July 19, 2007
• 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.
Forum Editor, Angioplasty.Org, July 17, 2007
• 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??
M.L., California, USA, July 16, 2007
• 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.
Forum Editor, Angioplasty.Org, January 7, 2007
• 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)
Wil van B., The Netherlands, December 28, 2006
• 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
Gary Franz, Fresno, California, USA, November 16, 2006
• 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.
Forum Editor, Angioplasty.Org, October 4, 2006
• 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.
Pratul Dalal, Mumbai, India, September 18, 2006
• 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!)
Dr Mo Samuels, cardiology resident, University of London, UK,
cardiology resident (zigwallah@hotmail.com) on Sunday, September
17, 2006
• 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.
Forum Editor, Angioplasty.Org, September 16, 2006
• 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.
Jack, California, USA, September 12, 2006
• 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.
Kevin, Albuquerque, New Mexico, August 4, 2006
• 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.
francis, north carolina, USA, July 26, 2006
• 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.
Forum Editor, Angioplasty.Org, July 22, 2006
• 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?
Carol, Atlanta area, Georgia, USA, July 21, 2006
• 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.
Forum Editor, Angioplasty.Org, July 19, 2006
• 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.
Ian, Chicago, Illinois, USA, June 15, 2006
• 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?
Jill S, Florida, USA, May 28, 2006
• 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
anil sabharwal, air india, delhi. india, March 20, 2006
• 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?
Les C.., England, February 5, 2006
• 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.
Forum Editor, Angioplasty.Org, January 5, 2006
• 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?
Tom Lin, January 01, 2006
• 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".
Laura Lamkin, Louisville, KY, October 03, 2005
• 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 T., Florida, USA, September 28, 2005
• 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?
Forum Editor, Angioplasty.Org, September 28, 2005
• 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?
Terry T., Florida USA, September 28, 2005
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