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My potions concerning CAD
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agapeman posted:
This is my first post and I'm here because of recently discovered heart issues. My doctor recommended I have a heart scan for calcium, (plaque in the heart arteries) and when that came back my score was 957 which I understand is extremely high, and they found six areas of concern. The biggest concentration was in the left artery and in the LAD. My doctor got me on a statin and I made radical changes to my diet immediately. I had a nuclear stress test 2 weeks ago and they stopped it before I was finished due to abnormalities in my ekg. The tech showed me the scans and said it was clear I had restrictions and one definite blockage going on on the left artery. Of course i am concerned, my doctor told me to quit jogging for the now and referred me to a cardiologist I will meet with next Thursday to get started and schedule most likely a angiogram. I'm a bit flipped out about all this and a lot of people count on me due to my profession which makes it hard for me to talk to anyone. My wife is great but she can't handle the details I'm trying to figure out and I don't want to overly concern her so I've come here for some support. I'm big on research and I may be getting ahead of things but the main question I have is how does a cardiologist determine if angioplasty and stents will do the job during the angiogram rather than pulling out and considering bypass instead? The Dr. said he will consult with me during the angiogram but should I have to make a call on that while I'm in the procedure? I'm aware of the debate between stents and bypass surgery and I want to fully consider my options if necessary. I've never had any health issues in my life before and am in shape and the waiting game and uncertainty about all this is weighing on me. Thanks for any input.
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billh99 responded:
The main thing that determine if revasculation is going to be done via stent(s) or CABG (bypass) is the SYNTAX score.

The syntax score is a value computed from the number of blockages and the location of the blockages. It also includes extra points if the blockages are at a bifurcation (split) of the arteries, extra long, etc.

The higher the score the more likely that CABG is the answer.

Besides the score they will also consider other things such as any other health conditions.

While there is a very small risk with CABG, as with an surgery, and the recovery is longer. Research has shown that when the revasculationcan be done by either stenting or CABG that CABG has better long term outcome.

In my case I just had some shortness of breath and fatigue. While I did not have an changes on the EKG I only lasted a few minutes on the stress test.

Angiogram showed 70% blockage in the left main right as it splits to the form the LAD and left circumflex. And another one in a diagonal off the LAD.

Because the blockage was at the split it was practical stent it. So I had a CABG.

With some equipment you can ask them to position a monitor so that you can see the angio process. In my case they could not do that. But as soon as it was over the repositioned the monitor and replayed the video and pointed out the blockages to me.

Here are a couple of sites that explain the angiogram (and other tests and procedures).

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

http://www.scai.org/SecondsCount/Resources/Detail.aspx?cid=23c0ae9d-36f7-410d-8bbf-89d662cdca97

Let me know if you have any other questions.


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