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Angiogram choices
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agapeman posted:
I saw a cardiologist last week and he has me scheduled for an angiogram next week due to abnormalities on my nuclear stress test and signs of possible blockage. I also have a high angaston score of 957 predominately in the LAC. He seemed to be rather laid back about how big of a deal this could be because I'm not having angina or shortness of breath. I was prepared for the appointment but later wondered why I didn't ask him if I should get a CTA which is non-invasive since he just wants to take a better look. Is a CTA (64 slice) a good option? They do have the equipment on site. I called his nurse and she is going to have him get back with me any opinions out there? Thanks
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James Beckerman, MD, FACC responded:
The benefit of the CT is that it's not invasive and therefore is lower risk than the invasive angiogram. In general, the CT does provide very helpful information as to the location and severity of any blockages. Typically, blockages are not opened with stents in the absence of symptoms. So it may be that the CT could be worth discussing further with your doctor.
 
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cardiostarusa1 responded:
Hi:

"He seemed to be rather laid back about how big of a deal this could be because I'm not having angina or shortness of breath"

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.

"Is a CTA (64 slice) a good option?"

Non-invasive 64-slice Cardiac CT allows doctors to view/examine the heart and the coronary arteries in never-before-seen detail.

Far better yet, the new blazingly fast (benefit of less radiation exposure to the patient, and less contrast media) 320-slice Cardiac CT scanners can measure subtle changes in blood flow, or minute blockages forming in blood vessels, no bigger than the average width of a toothpick (1.5 mm) in the heart, and the brain.

HeartSite

Cardiac Cath

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


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


Best of luck down the road of life.

Take care,

CardioStar*

WebMD member (since 8/99)



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Heart Disease TYPES

Men and Women

Acquired in life or congenital (born with it)

http://www.webmd.com/heart-disease/heart-disease-men

Heart Disease SYMPTOMS


http://www.webmd.com/heart-disease/guide/heart-disease-symptoms

Mayo Clinic

Heart Disease

Heart disease is a broad term used to describe a range of diseases that affects your heart and sometimes the blood vessels......

http://www.mayoclinic.com/health/heart-disease/DS01120

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The Heart: (Human Anatomy) Pictures, Definition, Location in the Body and Heart Problems

http://www.webmd.com/heart/picture-of-the-heart


How the Heart Pumps


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http://your-doctor.com/healthinfocenter/medical-conditions/cardiovascular/heartpump-tutorial.html


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Heart-Healthy Foods

Nothing complicated, just plain and simple

AVOID foods high in saturated fat and cholesterol. CHOOSE skim or low-fat milk, low-fat yogurt and reduced-fat cheeses. Eat more fish and poultry. LIMIT servings to five to seven ounces a day. TRIM visible fat. Limit egg yolks. SUBSTITUTE two egg whites for one whole egg or use an egg-substitute. Eat more fruits and vegetables, whole grains, breads and cereals. USE LESS salt and fat. SEASON WITH herbs and spices rather than with sauces, gravies and butter.


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.Good to know, for the primary and secondary prevention of heart attack and brain attack/stroke

Epidemiologic studies (EDS) have revealed risk factors (encompasses some new, novel or emerging) for atherosclerosis, typically affecting the carotid, coronary and peripheral arteries, which includes age, gender, genetics (gene deletion, malfunction or mutation) , diabetes (considered as being the highest risk factor), smoking (includes second and thirdhand), inactivity, obesity (a global epidemic, "globesity"), high blood pressure (hypertension), Low HDL (now questionable, according to recent studies) high LDL, small, dense LDL, RLP (remnant lipoprotein), high Lp(a), high ApoB, high Lp-PLA2, high triglycerides, HDL2b, high homocysteine (now questionable), and high C-reactive protein (CRP/hs-CRP).

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Quote!

"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!"

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agapeman responded:
I talked to my Cardiologist this morning and he explained that my stress test results were very clear that I had a restriction that he needed to look at by an angiogram and most likely fix with a stent. So any other testing wold be redundant. So I am going in for the angiogram next week. I just wanted to say thanks to all who replied, these forums help a person like me learn and understand what to expect.
 
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cardiostarusa1 replied to agapeman's response:
You're welcome, and thanks for the update.

Hope all goes well next week.

Take good care,

CardioStar*

 
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agapeman responded:
Update: I just got home from an angiogram, I was too medicated to remember much but a nurse friend of mine spoke with the Dr. and learned I have a 100% blocked LAD but the good news is that I have vigerious blood flow due to extremely good collaterals that have developed. Doc was a bit amazed. He said no further intervention at this time but continued meds and diet and exercise program. I'm still in a bit of a fog but happy that he didn't even stent me in another artery that had around 50% stenosis (back side artery). I will meet with him again in a few weeks and learn more. Any insight to what this news means? Sounds encouraging to me. Thanks for any replies.
 
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billh99 replied to agapeman's response:
but happy that he didn't even stent me in another artery that had around 50% stenosis (back side artery).

Typically it takes a blockage of 70 - 80% before it reduces the blood flow enough to need stenting.
 
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cardiostarusa1 replied to agapeman's response:
Thanks for the update.

......"the good news is that I have vigorous blood flow due to extremely good collaterals that have developed. / Any insight to what this news means? Sounds encouraging to me.

Coronary artery collaterals (a natural development, a gradual process, one's own "bio-bypass" so to speak) involves tiny (rescue or backup) vessels, that connect two larger coronary arteries or different segments of the same artery. These vessels provide an alternate route for blood flow to the heart muscle (myocardium) when called for in an emergency.

Those who have well-developed (and open) coronary artery collaterals are the lucky ones (as my father was), because this form of blood supply helps protect the heart from an attack, or limits the damage to the heart muscle from tissue death if/when the normal blood supply is totally cut off (100% blockage).

The main drawback is that these collaterals are not really meant to carry the whole load of the heart, though they may/can provide significant blood flow in some individuals.

These vessels seldom delivers the same amount of blood flow that the unblocked native artery or arteries originally did, but the blood flow may be/can be enough to ease/reduce chest pain/discomfort in some individuals and reduce the risk of a serious heart attack or death some time later on.

......"but happy that he didn't even stent me in another artery that had around 50% stenosis (back side artery)."

Cardiologists typically consider/perform angioplasty, with or without coronary stenting (especially if concerning symptoms are present) if/when there is a blockage/narrowing/stenosis of 70%/75% or greater in the right coronary artery (RCA), the left anterior descending artery (LAD), the left circumflex (LCX), and some of the respective branches of these arteries.

Take good care,

CardioStar*

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Be well-informed

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.htm

 
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readingbuff replied to James Beckerman, MD, FACC's response:
What about Lexiscan? Mine lead to a cath, 95% LADA blocked and a stent. The cath and stent were done in the Cath Lab one after the other. The Lexiscan was invaluable in diagnosing my angina.
 
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cardiostarusa1 replied to readingbuff's response:
Hi:

"What about Lexiscan?"

"The Lexiscan was invaluable in diagnosing my angina."


The main problem with either pharmacologic or exercise nuclear stress tests, is that from time-to-time, can yield a false-negative or false-positive result.

One example, and at the very extreme, a nuclear stress test can appear normal in some individuals with multi-vessel coronary artery disease (CAD), said to occur due to so-called "balanced ischemia".

Lexiscan

https://www.lexiscaninfo.com/lexiscan/aslex_web_default.html


The bottom line

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

Coronary artery disease (CAD) is a lifelong unpredictable (may/can exhibit periods of stabilization, acceleration and even some regression) condition requiring a continuum of care.

Take care,

CardioStar*




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-


Quote!

"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

.

It's your future......be there.

. .


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

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


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