100% blockage treatment

[notgwen]

My 50 yr old husband just had a heart cath.  Has had no heart symptoms, just a family history of heart disease (dad passed at 52).  He has high blood pressure that has been under control for about 7 years.

Results of cath were 100% blockage of 2 arteries and 40% of 3rd.  Doctor wants to proceed with only Crestor to keep blockage from getting worse.  

He was on Lipitor a year ago for 7 months and it did not even budge his cholesterol levels.  

Why would they not want to clear the blockage instead of wating for the only remaining 60% to close?

I think we need a second opinion...

[erijon]

Whenever I need input on a question like this, I reach out to Flycaster and Ed. Like Skydnsr I agree with Flycaster and Ed, but I usully do. There's little knowledge like experience.

[skydnsr]

In a lot of cases, the doctors can't do anything for a 100% blockage without open-heart surgery, and OHS carries significant risks.   It's all about balancing risks, at this point.  There's no course of action to treat your husband's heart that's risk-free.  It's a matter of choosing the course of action, out of the options that are available,  that seems to have the least risk.  Trying a different statin is pretty low-risk, and it might help.  The fact that your husband has no symptoms makes it unreasonable to try higher-risk treatments, at least for the time being.  If he were in pain or if he were unable to do things that he needs to be able to do, that would be different.

I agree with ed34 and Flycaster that for your husband to have no symptoms in this situation means that he has to have developed collateral circulation.  When doctors don't explain things like this to you, it is because they don't realize that it is going to bother you not to have an explanation.  To them, a patient who has no symptoms is doing fine.  

[ed34]

The fact that he has given up smoking will make a HUGE difference and certainly lower his risks considerably. Personally, I found no diet changes made any difference for years, until newer research seemed to suggest an association with processed sugar and heart disease. I cut down my sugar intake ( I consumed LOTS) and suddenly I didn't need stents any more.
If they did nothing for the totally blocked arteries, you need to ensure that the 40% blocked artery doesn't get too much worse because this is his lifeline. This will be the vessel giving blood to the blocked ones. He will know when the blockage is getting worse, by increased shortness of breath and pains on exertion. Cold air will also start to affect his symptoms. If he feels any form of Angina like this, then please ensure he visits a cardiologist and you must explain your concerns that this is the vessel giving him a life line.
I wouldn't worry, he isn't going to have anything bad happen and he has a lot of life left yet. I was in exactly the same situation in 2007 and things are looking great still.

[Flycaster305]

I'm not sure about Ed34, but believe he also has 100% blocked arteries, as do I.  I'm still standing on the sunny side, as it Ed34 who has also experienced huge stressful experiences.  We are developing collateral arteries. Tonight I enjoyed a wonderful time with friends as a neighbor came home after a long hiatus, I'm still standing.
It is routine for doctors to report these kind of conditions, but these boards can help people through peer to peer support understand that there is hope. Changes is lifestyle are so important.
Keep us informed.  

[notgwen]

He was told he did not need to alter his diet. Our daughter is 20, a gymnast, and has been on meds for cholesterol for 2 years...I suppose it's just genetic.
He was told to quit smoking. He has.
He is a carpenter so he has a physically demanding job. He was told NO competitive sports.
There was brief mention of other vessel picking up the slack for the blocked arteries.  Nothing was done for the totally blocked arteries.
I just feel like it is so routine for the docs...it isn't for us.
You guys really helped me see the rationalization of the lack of action. Thanks.

[Flycaster305]

I certainly agree with Ed34.  I don't think you would get your insurance company to cover removing a 40% block, and remember, blockage treatments are somewhat invasive.  

Sometimes different cholesterol medications work better on some individuals than others, and I'm guessing your doctor wants to try a different one to see if it is more effective.  That being said, has your husband changed his diet, increased exercise, avoided smoking/second hand smoke, etc.?  Controlling heart blockages is a very broad-based issue.

Hope you keep us informed.  

[ed34]

Well, the 40% is not necessary to be treated, especially as he has had the other 2 done. If he had two arteries blocked at 100 % then he wouldn't be here today unless collateral vessels had opened to form a bypass. Those collateral vessels would probably have been fed by the 40% blocked artery. So, the cardiologist had 2 choices really. Leave the two 100% blockages and treat the 40% to get a bigger flow or leave the 40% and treat the two 100% blockages. It is usual policy to not treat a blockage less than 70%. It's because of the risk factor involved. If they ballooned the 40% artery and it tore, causing internal bleeding, or if he lost some plaque from it causing a stroke, then everyone would be sorry it was attempted. Only when blood flow is restricted will they treat it. Coronary arteries are bigger than they need to be, so 40% is small, because 50% is basically reserve.