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CAG or not ?
An_256284 posted:

I am 50...had a trouble free 49 yrs . Dont smoke, vegetarian, no booze...generally healthy eating (not much fried...) No diabetes, not much overweight (80 kgs max at 175cm ht), no hypertension, cholesterol on lower than borderline.

I have had two life insurance policies granted bout 15 months back after thorough check up...and I do one annually. The current one said "stress test mild positive for provocable ischemia" though it took a while to reach the required heart rate (says good effort tolerance).The consulting doc advised CAG to rule out a problem and prescribed some drugs which he said I need to take life time. My employer's doc advised doing a PTCA along with CAG...looking at what angioplasty is, has really shaken me up !

Though I have been asymptomatic till date, since the medical, I am constantly plagued by the thought of becoming a heart patient and keep imagining I have breathlessness OR a discomfort in the chest. Can I go from healthy to heart diseased in an year ? Should I get the CAG and stenting done ?? What are the risks / undesirable reactions ?

Any words to help me relax ?

(Frightened out of my wits)
cardiostarusa1 responded:

"Can I go from healthy to heart diseased in an year?"

It's possible.

In fact, one second you can have a totally clear coronary artery (as imaged with coronary angiography), and then WHAMMO, a vulnerable plaque (VP) ruptures or bursts, resulting in blood clot (thrombus) formation, causing a heart attack, sometimes being instantly fatal.

VP (a 0% blockage, though unequivocal atherosclerosis, and typically symptomless) is now recognized worldwide as the cause of the majority of heart attacks.

Most of the plaques involved in coronary artery disease (CAD) are not the plaques that significantly narrow the artery.


"Only one in seven heart attacks is caused by a blockage of more than 70 percent. It's the classic tip of the iceberg problem. We've become facile at treating the tip of the iceberg, BUT the most dangerous part is still below the surface."

- Steven E. Nissen, M.D., vice-chairman of Cardiology, head of Clinical Cardiology, Cleveland Clinic

"The angiogram is just shadows, it doesn't tell us what's going on in the vessel wall, where all the action is at."

- Eric J. Topol, M.D (formerly of the Cleveland Clinic)., cardiologist, professor of medicine, Department of Molecular and Experimental Medicine, chief academic officer of Scripps Health and director of the Scripps Translational Science Institute

Additionally here, It has been known for quite some time now that atherosclerosis begins (the process/progression of) at a very early age, even as early as in the pre-teen/teenage years.

Studies performed in the past have shown fatty streaks (represents the earliest precursor to plaque development and plaque is the pathological hallmark of atherosclerosis) as the beginning of atherosclerosis in the coronary arteries. Soft plaque (more dangerous and unpredictable than hard or calcified plaque) is the early stage of atherosclerosis.

"Though I have been asymptomatic till date"

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.

Also as reported, a risk factor merely increases the probability that one will develop cardiovascular disease, BUT doesn't 100% guarantee that one will develop it, nor does its absence (or even the absence of ALL known risk factors) 100% guarantee that one won't have a heart attack or brain attack.

Invasive coronary angiography (angiogram, heart catheterization, **carries risks and the possibility of complications, some unforeseen) is still considered as being the "gold standard" for imaging blockages/determining the % of narrowing.

Doctors may consider/perform **angioplasty, with or without **stenting, on blockages of 70%75% or greater, especially if concerning symptoms are present.


Heart info, cardiac tests info, actual diagnostic images

Cardiac Cath

Coronary artery anatomy

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

Also see: Drug-Coated Stent

PTCA or Balloon Angioplasty

Best of luck down the road of life.

Take care,


WebMD member (since 8/99)



Be well-informed



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