Coronary Arteries

[bwanadar]

Background history of Ischaemic heart disease having coronary artery bypass surgery in 1998. (LIMA to LAD, radial artery graft to left circumflex and a vein graft to first diagonal). Also hypertension.
Treatment: Aspirin, (75mg/day), losartan (100mg./day), nicorandil (15mg.twice/day), Amlodipine (10mg/day).
Recent Anginal pain has led to further cardiac catheterisation with the following results:-
LV Angiogram:- Good functioning Left Ventrical.
Coronary Arteries:- Left Main Stem Normal.
LAD - The LAD seems to be occluded quite proximally.  It gives rise to a decent first septal perforator which seems to be diseased throughout.
Circumflex - The circumflex is a chunky dominant vessel with no obtuse marginal seen, however the terminal part of the AV circumflex has got 60 - 70% long segment of diffuse disease.
Right Coronary Artery - small non dominant vessel with moderate diffuse disease throughout.
Grafts: LIMA to LAD not selectively engaged, however limited views show the graft to be very well patent and supplying LAD without any problems.
Vein Graft to first diagonal widely patent no problems.
Radial graft ot distal circumflex could not be identified.  Aotic root angiogram was done but the graft wasn't seen on that either.  The assumption here being is that it is probably occluded.
Conclusion:- Three-vessel coronary artery disease of the native arteries with good functioning left ventricle.  LIMA to LAD and saphenous vein graft to diagonal patent, presumed blockage of the radial artery graft to distal circumflex.
Recommendation given to me are to continue with medical management with intensification of anti anginal treatment.
In my ordinary way it feels to me that I am heading towards a slippery slope.  When I had the coronary bypass 10 years ago my life changed for better, I am fit with good decipline towards my eating habits and proper excercise regime.  I will be 65 years of age by February.  I am told further surgery could be of disadvantage, is this true?  I am in search of better explanation towards my heart problem and cosequences towards trying to lead a quality life rather then feel that "life sentence" has been passed.  You views and better explanation would be greatly appreciated.
Many Thanks.

[bwanadar]

Thank you for your encouraging comments.  I wish you all the best with your health.  May I take this opportunity to wish you and your family a merry christmas and a happy New Year.

[kenkeith]

I agree with your doctor.  There is a probability of complications associated with surgery, and medical management of angina does not forgo any option for longivity with an interventional procedure.  Google "COURAGE study" and the study shows that medication therapy when weighed against stents or a bypass does not decrease life span, but all appear to have the same risk or lack thereof for normal life spanmortality.

If medication does not provide relief from angina, then a stent implant may be the recommended intervention.  Sometimes, due to size, location, and an emergency a bypass is the correct procedure.  

I have a totally blocked LAD (collateral vessels provide bypass), circumflex 72% blocked, and a stented RCA.  My condition has not changed for the last 5 years with medication, exercise, proper diet, etc.  

You have good left ventricle functionality, etc. that may be due in part to taking care of yourself.  Medication to relieve angina relaxes and dilates coronary arteries...the dilatation may be an opening as large or larger than a stent.