Heart Disease Community

Hi:

Doctors typically consider/perform angioplasty, with or without coronary stents on blockages of 70%75% or greater in the right coronary artery (RCA), left anterior descending (LAD), left circumflex (LCX) and some of their respective branches, also taking in consideration present symptoms and the severity thereof.

As reported, the symptoms of artery-narrowing atherosclerosis are highly variable. Those with mild atherosclerosis may present with clinically important symptoms and signs of disease and heart attack, or absolute worst case scenario, sudden cardiac death (SCD) may be the first and only symptom of coronary artery disease (CAD). However, many individuals with anatomically advanced disease may have no symptoms and experience no functional impairment.

Recovery can be relatively quick and painless (except for the catheter insertion site) for many coronary stent patients, especially if no heart attack occurred, though complications, some unforeseen, may/can occur at any time, such as chest pain/discomfort or other, as well as dreaded side effects from prescription drugs (which can delay/hamper the recovery).

Coronary stents (bare-metal or drug-eluting) are only a Band-aid or spot-treatment though, as it doesn't address the disease process and what drives the progression.

It has been reported, that in some individuals, it's possible to halt or reverse atherosclerotic plaque in the arteries to some degree, through lifestyle changes, statin-therapy (**typically high-dose as seen in clinical trials), strict, uniquely-customized or highly-specialized diet (e.g., Ornish), exercise regimen, and stress management.

**Intensive Cholesterol Lowering With Atorvastatin Halts Progression Of Heart Disease, Cleveland Clinic-Led Study Shows

'REVERSAL' Trial

The REVERSAL trial, compared the highest doses available at the time of two popular statin drugs, pravastatin and atorvastatin....

"When we analyzed the results of REVERSAL, we realized that we had found an approach to coronary disease treatment that could literally stop heart disease in its tracks"......

http://www.sciencedaily.com/releases/2004/03/040309071559.htm
The bottom line

Coronary artery disease (CAD) is a lifelong unpredictable (may/can exhibit periods of stabilization, acceleration) condition, requiring a continuum of care, as well as good doctor-patient/patient-doctor communication and understanding at ALL times.

Best of luck to your father down the road life.

Take care,

CardioStar*

WebMD member (since 8/99)




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Living With Heart Disease

Coronary Artery Disease (CAD)

CAD is chronic disease with no cure. When you have coronary artery disease, it is important to take care of your....

This is especially true if you have had an interventional procedure or surgery to improve blood flow to the heart.../It is up to you to take steps....

Recognize the symptoms......

Reduce your risk factors......

Take your medications......

See your doctor for regular check-ups......

http://www.webmd.com/heart-disease/guide/living-with-heart-disease


Coronary artery anatomy

Starting with the left anterior descending (LAD), the most critical, next to the ultra-critical left main (LM).

http://www.heartsite.com/html/lad.html

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The coronary arteries are classified as so-called 'end circulation' since they represent the only source of blood supply to the heart muscle (myocardium). There is very little redundant (auxillary) blood supply (unless sufficient coronary artery collateral circulation has developed), which is why a blockage or blockages in these can be extremely critical.

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"Be a questioning patient. TALK to your DOCTOR and ASK QUESTIONS. Studies show that patients who ask the most questions, and are most assertive, get the best results. Be vigilant and speak up!"

- Charles Inlander, People's Medical Society

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WebMD/WebMD forums does not provide medical advice, diagnosis or treatment.

WebMD does not endorse any specific product, service or treatment.

I typically do not recommend stents unless (1) a person is having a heart attack or (2) the person has a significant blockage (generally more than 70%) and continues to have symptoms despite optimal medical therapy. The cardiology community is trying to avoid placing stents in people who are asymptomatic or who have not been placed on optimal medical therapy.

3 years ago I had SOB and only lasted 4:30 on a stress test. Had 70% in left main and oblique margin. Had a CABG.

Last spring I had stress test and lasted 10:45, but the echo showed an area of possible hypokenetic motion at the very bottom of the heart.

My cardiologist cardiologist said that it could be a) a place that was missed on the initial angio, a bypass that limited the flow, or a new blockage.

But that the small area it was up to me if I wanted an angio.

While I am a bit obsessive and would really like to know what was going on I also realized that medical there was nothing to be gained. No angina and no problem exercising, include 35-60 mile bike rides.

So I said no.

Hello Dr.James,
I just got the Summary Report and here are the findings it stated.
1. Mild Calcium Burden
2. Triple Vessel disease with complex plaques in LMCA with upto 63% stenosis, calcific plaque in LAD (<40%) Osteal Stenosis of LCX upto 50%, Stenosis of Proximal Right CA (55%).
3. Angio Correlation Suggested.

PS: He is Diabetic which is under control. could you please comment on those symptoms?. He is scheduled for Coronary Angio next Monday.

Is your father having any problems from this?

Shortness of breath.
Angina.
Inability to exercise.

No he doesn't have any complaints.
He starts his day with Yoga (deep breathing and few other postures) and then goes for about 3 miles walk. Eats Sprouts with pomegranate. And in the evenings he walks about 2 miles. In the morning walk he runs for about half a mile and he takes stairs everyday and never complaints Shortness of breath and never feels tired. And he never has Angina too.

I am not a medical professional just a patient.

But I am wondering why he even got the CT angio in the first place.

From my understanding from the current recommendation that if the partial blockage is not causing any problems that there is no reason to stent at this time. And the only reason for for the angio is to see if a stent is needed.

As I mentioned above I did not get a angio when I was able to complete a treadmill test and did not have any symptoms.

Instead look at the treatable factors.

Treat cholesterol levels, if needed.
Treat high blood pressure, if needed.
Stop smoking, if needed.

Diet, exercise, and weight control. Which it appears that he is doing.

But one caution. From the name I wonder if he is from India. I believe that in parts of India that gee is commonly eaten and that can be a problem with the high saturated fat levels.

Hi Bill,
First of all thank you so much for your inputs and suggestions.
> The reason for him having CT angio was, He goes for physicals almost once a year as he is higher 50s and Diabetic. When he went 3 yrs back, they identified partial blockage and went with treadmill test and he passed that. So, his cardiologist put him on medication (at that time also my father din't have any complaints of chest pain, shortness of breath but cholesterol levels were little high. Since then, he keeps visiting but due to lack of those symptoms, they haven't done CT or something. But he is planning his visit to US for 6 months next month hence we thought of consulting Dr. once to check his heart conditions and that's the time they did CT Angio. Since they identified that blockage being increased from 40 to 63% in last 3 yrs, his Dr. Suggested Coronary Angio.
Now his cholesterol levels are normal and blood pressures levels and sugar levels are also normal. And he doesn't booze and smoke and Don't consume Ghee.
Thanks Again
Vijay

He needs a very low fat diet, plus more pomegranate products.
No fatty meat or dairy products. And more strenuous exercise.

I am a recovered triple bypass patient living an active life.

Sign me, DeadManWalking, Rowing, Hiking, and playing basketball and volleyball.