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Is This Angiogram / Angioplasty Necessary?

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Current Postings on This Page (8):

• JimH - We can't give medical advice on the net, but this is certainly a good question to ask your cardiologist, or the doctor who booked you for the angiogram. Anginal pain from exertion, if there is a blockage, comes from the heart not receiving enough oxygen. Soreness from your chest wall inflammation normally would have a different more localized cause, but again, ask your doctor about this. There are alternatives to an invasive test, such as a Cardiac CT, but not all centers are equipped to do this. Also, if anything shows up, you'd most likely have to get an invasive angiogram anyway. That being said, virtually all angiograms done in the UK today are done via the wrist access, which has reduced complications for the most part and makes the procedure less unpleasant for the patient. Good luck and let us know the results.
Angioplasty.Org Staff, Angioplasty.Org, July 19, 2022

• I have a coronary angiogram booked in three weeks. This was advised because I get chest pain on walking (typically after, say, 500 metres), which ceases within a couple of minutes when I stop walking- a classic angina symptom. However, when I press on the chest wall on the left, there is always an area which is sore and tender to the touch; this is associated with costochondritis (or chest wall inflammation). The two symptoms-pain on exertion and pain on palpation- are treated as if they are mutually exclusive in the medical articles I have read. Is it possible that if you have angina it could also cause pain on palpation? Following from this question, is it a good decision to have an angiogram for this combination of symptoms given that it is potentially very unpleasant procedure?
JimH, UK, July 9, 2022

• Tom -- sorry you're confused -- hopefully it's not because of our articles, but because there has been much confusion around the results of the COURAGE trial. OK. Number one. A blockage does not necessarily mean you're at risk for a heart attack. It is currently believed that heart attacks are caused by "vulnerable plaque", a coronary artery plaque that ruptures releasing all kinds of thrombus-inducing material into the blood stream, causing clots, and subsequent blockage of blood flow. These plaques are not necessarily large ones that would be seen on angiography. However, they CAN be seen using other techniques, such as intravascular ultrasound (IVUS). The question on whether opening up any blockage is always, "Is it obstructive?" That is, does it reduce blood flow to the point that (1) it causes angina; or (2) it is so narrow, and in a major artery, that any small clot could cause a major event. To answer your question, all these trials and studies try to point to what could be called "best practice". What the COURAGE trial DID show was that stenting could be safely deferred in the patient population covered by the COURAGE trial -- namely low risk patients with stable angina. Other types of patients, such as the scenario you describe, cannot be automatically included.
Angioplasty.Org Staff, Angioplasty.Org, April 23, 2007

• After reading Angioplasty.Org's articles commenting on the "COURAGE" TRIAL", I am little confused. What about this scenario: An individual is currently experiencing NO angina or other symptoms, but since routine tests are questionable, a subsequent angiogram reveals previous double-bypass done four years ago has failed (closed), and patient is back where he started from with 80% blockages involving the distal left main & the ostium of the left circumflex artery & the left anterior descending artery (but, as I said, with No current angina). Are we to conclude that since this time there is no angina or other symptoms, that rather then using stents or attempting another bypass that the patient should initially treat this with medications only? And if so, is not the patient risking a sudden massive heart attack during this treatment, since blockages in those areas are rather serious?
Tom T., Arizona, USA, April 23, 2007

• Jay -- read the articles listed in the right-column side-bar. They talk about the COURAGE trial which showed that angioplasty and/or stenting did not prolong life or prevent heart attacks in patients with stable angina and relatively low risk blockages. Stents did, however, reduce angina (chest pain) and improve exercise tolerance better than drugs alone -- which is really why angioplasty is used. There has never been a study demonstrating that stents or angioplasty prolong life or prevent heart attacks better than drugs. We recommend that you inform yourself and then discuss these issues with your cardiologist. Many have warned against the oculo-stenotic reflex -- where cardiologists do diagnostic catheterizations and, if they see a blockage (a.k.a. stenosis), they unblock it in the same session. There are plusses and minues to this approach, also called "ad hoc angioplasty". The plusses? The patient doesn't need to undergo a second catheterization. The complication rate for catheterization is somewhere between 3-6%, mostly around the femoral artery entry point. So by doing everything in the same session you minimize the complications. Also the cost is reduced. The minuses? You eliminate a less invasive option, which is trying medical therapy to alleviate the symptoms and going back with a stent only if that doesn't work. All of this is a complicated issue. Our advice is to discuss these concerns with your interventional cardiologist BEFORE getting into the cath lab -- decide together what the best course of action is, and then proceed in confidence and understanding that you are doing the right thing. You might also ask whether a 64 slice CT scan might be a less invasive diagnostic first step. Again, your cardiologist may have very specific and very good reasons for stenting. And there's no problem asking what they are.
Angioplasty.Org Staff, Angioplasty.Org, April 23, 2007

• Thank you for your web-site and its wealth of information. I am 49 y/o man, active with no symptoms of heart disease. I have mild hypertension and a family history of heart disease. Last week I had a stress test at my first-ever visit to a cardiologist. They suggested angiogram immediately, and informed me if they found blockages, they would treat then-and-there with angioplasty and stents. I am concerned about doing too much too quickly. Are there alternative treatments to using stents?
Jay B., Arizona, USA, April 23, 2007

VL -- 70% blockage is what the very provocative COURAGE trial just looked at, and found that in low risk patients with stable angina, there was no difference in survival or incidence of heart attack between those who had optimal medical therapy or those who also had a stent placed. The take-away from the study was that for those patients, there was no "emergency" to have a stent placed. Of course, you need to discuss with your cardiologist if you are part of the patient population studied in the COURAGE trial -- or at higher risk.
Angioplasty.Org Staff, Angioplasty.Org, April 12, 2007

• I have a 70% blockage of right anterior artery, diagnosed by angioplasty, 65% EF, just became 78yrs, female. Dr. says I must have stent or heart attack. Scheduled for Apr. 19, but wonder why there is such a hurry. I have a cat scan coming up in June to check for metastasis and am concerned about being on plavix if surgery is needed. I am asymptomatic and would like to delay stenting. Am I being unrealistic?
VL, Florida, USA, April 7, 2007

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