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LAD artery 60% blockage, ECG confirms slient MI in past 6 months
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asrakheja posted:
Hi,

My father is a 65 years old chronic type 2 diabetic (insulin dependent since 1976). He went for a routine full body check up about a month back (1 Jan 2014). His sugar, BP, and cholestrol levels were all on the higher side. Also, his Echo and ECG reports showed symptoms of a recent MI, althought my father does not seem to remember any discomfort/pain/relevant instance

Given that there were no symptoms felt by dad, the doctors asked for a CT angio. The report gives the following details:

Calcium score: RCA 2.54, LM Nil, LAD 7.41, CX Nil, Total - 9.95

The results for Left Coronery artery, left main stem and ramus intermedius, left circumflex are normal.
However, for Left Anterior Descending (LAD), 60% stenosis is reported for the proximal part. Thereafter, the mid and distal parts of the LAD shows signs of variable stenosis, with the narrowest segment being approx 80% stenotic
Right Coronery Artery shows stenosis < 50%
The fresh ECG report confirms recent MI (old ECG was done 7 months ago in July 2013, it was alright). A troponin test was also conducted, it shows enzyme levels at about 0.6 (20% higher than normal range)
We have consulted 3 doctors and each doctor has a different view. 1) One is of the opinion that dad should be immediately admitted and a angiography + stenting procedure should be done without any delay given the recent ECG and troponin test results. 2) Second is of the opinion that stenting has chances of failures so if the angio shows that more than 2 stents woud be needed, dad hould go for a by-pass. The procedure, accordingly to him, can wait for about 15 days, while is has to be treated, there is no rush. 3) The third doctor says 60% is not high enough for a stenting procedure, and that dad should continue with recently prescribed medicines and lifestyle changes, and wait for few months before getting a angio done to check if there has been an improvement
We are completely confused, more so with mind set in medicine India due t which it gets difficult to trust anyone.
Please advise at the earliest possible. THanks a lot in anticipation
Reply
 
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billh99 responded:
I am not a medical professional, but rather a patient.

But I try to follow the studies.

Except for the specific blockage that is causing a heart attack stenting other blockages does not improve life span any better than optimal medical treatment.

What many people don't realize that most heart attacks are caused by plaques that are in the size of 20-40% blockage. Larger plaques are stable and less likely to rupture.

However the can still slowing grow. And it is not until they reach 70-80% blockage that symptoms such as angina or shortness of breath start. At that time stenting or bypass is considered if the symptoms aren't controlled by medicines.

Also studies have show that when "complicated stenting" is required or for diabetics that bypass has better long term outcome.
 
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asrakheja replied to billh99's response:
Thanks a lot - helps !

We are meeting another senior cardio today, let's see what he has to say.

Hope it does not add to the confusion. I might revert with additional queries tonight.
 
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billh99 replied to asrakheja's response:
Here is an article that helps explain stenting vs CABAG.

http://www.cardiachealth.org/coronary-artery-disease-treatment-prediction-models

FEV1 is an measurement of lung functioning.

SYNTAX is a computed number that represents the number of blockages that need treatment and how difficult that they are such as if they are in a bend or they are where a artery branches off.
 
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asrakheja replied to billh99's response:
Ok, so we had a convetional angio done, and results vary significantly from the CT angio.

The LAD shows 80% proximal stenosis, and then 90% plus stenosis at multiple places.

The other arteries are fine, show minor traces of soft plaquing.

The doctors have ruled out angioplasty as the artery is blocked at a rather longer stretch at one point which increases risks of restenosis/complications.

They recommend by pass at the earliest

Let me post a new discussion topic with the new found details and seek your valuable opinions.

Thanks for all suggestions so far - really aprreciate it


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