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:
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
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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