64 slice ct scan

[jonjon49]

I recently had a 64 slice ct scan  showing 50 per cent blockage and 35 percent blockage I am a 49 year old healthy male, eat a good diet,run 5 miles a day, work out 4x a wk, 5"10""183 lb ,my cholesterol is normal , my resting heart rate is 60,my blood presure is 120 over 70 I believe,  my cardiologist has me on 40mg of lipator and 10mg of zetia .My questions are is there any other ways to reduce the current blockage? Is my blockage considered alarming ? what type of blockage should someone my age expect to have? ps,I did smoke for a few years in my 20s and my diet was not the best.Thank you for your time Jon

[Jillejam]

They are doing it to find out if I have ARVD (arrythmogenic right ventricle dysplasia) a genetic disorder.  They will be looking for fatty fibrous tissue instead of muscle in my right ventricle.  I have VT problems and have an ICD that was inplanted on July 6th while I was on vacation in TN.  Actually I just today received a copy of my medical records from the ER of my first hospital visit.  I am looking at everything they did to me....cardioverted me 3 times.  Thank goodness I was knocked out for that, would have not liked being awake for it.  I also just learned that I went into VF between shocks 2 and 3, that was news to me.  Anyhow two months later and we are closing in on a diagnosis.  See, I am just a rookie....LOL
Thanks
Jill

[Jack54]

Yes I have had a Swan-Ganz right side heart cath when I had the roto at UAB. The temporary pacemaker was put in through my femoral vein. The neck doesn't sound so good, lol, but is probably more safe? Ask them if they can do the groin again...if you prefer that method.

Why are they doing the biopsy if you don't mind me being so nosy?

[Jillejam]

Hi Jack....Have you had the Swan-Ganz right side heart cath?  I am having this procedure done along with the biopsy.  The thought of going through a vein in the neck is not a pleasant idea to me.  I have already had the ep study through veins in the groin, not so bad but some reason having it up by my face makes me nervous.  Let me know what you think.  
Thanks
Jill

[Jack54]

I just read up on stenting of the left main and shezam, they do it all of the time! Not so long ago these blockages were only bypassed. I feel so much better for the both of you, and myself.

Stenting of this artery is unlike stenting any other artery. Joed9, since stenting of the left main is fairly new, I would want the best possible interventional cardiologist available at whatever hospital you choose. I would also ask if the hospital has the IVUS technology (intravascular ultrasound). I am sure that they do, if they are the best in Indiana :)  This technology is a must.

As far as a second opinion goes....well, the stenting should probably be done during the initial cardiac catheterization. It is hard to tell a cardiologist not to "fix" you, if he sees the need for the fix is urgent. These angiograms are recorded onto a cd. If you were discussing bypass surgery versus stenting as a treatment, then you might have the cardiac cath and angiogram performed without treatment, unless an emergency arose.

Then you could get a copy of the cd and take it around town or the whole USA letting surgeons and cardiologist give you their opinion. It is amazing to watch your heart beat and see the blockage(s) when the contrast dye is injected.

This is why I like to do my homework in advance. I go with the very best and let them proceed. I put all of my faith in them, and most of all, the Almighty and I stop worrying. Worry stresses the body. I want to help these doctors as much as I can. The Good Book tells us not to be anxious :)

Once I had a cath on an outpatient basis. During the cath the doctor explained my blockage and said that "we normally bypass these types of blockages". They do not stent at the outpatient facility. So I had a little time to ponder the situation. I asked if it was anyway it could be stented. (This is at the best hospital in north Alabama :) He said let me talk to our stent expert. I was in the hospital at this time and very close to checking out through the morgue (the 70% blockage he had seen in my LAD, turned out to be a 95% blockage using IVUS) at UAB. He came back and said, yes our stent expert says he will try it, but that if it did not work, he would have to call the bypass surgeon.

I smelled a rat very quickly, lol. I knew their plans so I asked if UAB hospital (University of Alabama in Birmingham) could stent it. The call was made, UAB said they could and I rode 100 miles south in an ambulance and got my stent. Prior to this stent, I could barely take care of myself. I have never felt so bad before.

So the moral of the story is make sure they mean they can stent it, because you will have to sign legal paperwork authorizing them to perform bypass surgery, or anything necessary to save your life.

Ask them:

1) How many of these procedures they have done and specifically your doctor, and what is their rate of success. I would want to see this on a data sheet. There are too many cardiologist wanting to try this procedure (probably) just for experience which they must have.

2) Ask what cardio/thoracic surgeon is likely to be on standby during your cath. Check out this surgeons credentials prior to the cardiac cat. Check out your interventional cardios credentials and background of course. All of this information should be on the hospital's web site.

3) Ask if you will also have a right side heart cath (Swan-Ganz) to "hook up" a temporary pacemaker, while you are having the left side heart cath and stenting.

4) Ask if a debulking procedure might be necessary. This is called rotoblational arthectomy or rotational arthectomy and involves a tiny acorn shaped cutter that spins at over 400,000 rpms.

5) Ask what type/brand of stent they will use and read up on it.

6) Ask how much conscious sedation you will have. You will be aware of all that happens unless they get you on the high side of sedation, lol. They need you awake to lift your arms and hold your breath, etc. You will not feel a thing unless it is angina when the balloon is inflated in your left main, and it only last a few seconds. It blocks all or most blood flow through your left main for a few seconds.

7) Ask if you can inject yourself with heparin for 2 weeks after the surgery, in addition to Plavix and aspirin. I did this and I believe it saved my life after the roto deal. Heparin is an anti-thrombotic drug you insert around your navel (all over your belly) and it stings, but is well worth the pain to prevent a blood clot. (I couldn't take aspirin and I believe this is why I had to use the heparin for 2 weeks post procedure)

I may have left out some other questions, but will be thinking about it.

What if they find that the heart scan was wrong? I do not know if this is 64 slice technology. I will check, but I hope and pray that they find nothing during the cardiac catheterization to perform the angiogram.

I have something like a 20% blockage in my left main. My problem is where my left anterior descending artery (LAD) branches off of the left main. I have 4 stents end to end and cannot have any more stents because it would take away the opportunity to bypass my LAD, which is what I hope to get done at the CC on or about 9/21. I have a blockage of ~35-40% in the middle of this mess of metal. CAD progresses very fast in me, probably because of high cholesterol and a "very short" left main. Statistics show that blockages downstream of a very short left main happen more often and at a faster pace.

A cardiac cath is a piece of cake. I have had 9 and will have my 10th on 9/19. Getting my teeth cleaned hurts much, much more than a cath :) You do have to lay still for a few hours until your artery seals or the tiny cut in it coagulates.

I love the CC and would advise anyone to get any heart related procedure done there.

Neither of you know for sure what is inside of you left main yet, so please be at ease. Get some anti-anxiety medicine for temporary use before any procedures.

As MysteryChemist says, none of us are doctors here, but we can share our research and experiences. Everything that I say must be taken with a large grain of salt cause I ain't just right in the head after 2 strokes :)

The best to both of you,

Jack

[MysteryChemist]

I had stent put in after a heart attack about 18 months ago.  It was put in the circumflex artery.
It was a piece of cake.  I didn't feel a thing after they started the drugs although the cardiologist told me afterwards that I talked my head off.  Since you don't have the heart attack, you should be up and about in no time.

I think the biggest question about stents is to decide which type, bare metal or DES, that you want put in. I have a bare metal stent and haven't had a problems but bare metals have a higher rate or restenosis; they can close back up.  DES ( drug or medicated stents) don't have this problem but they have recently been shown to have a small but significant risk of heart attack after they take you off Plavix. (Plavix is blood thinner).  Right now, if you have DES, they want you on a Plavix for at least a year although some Drs think you may be on Plavix for life.  You must be prepared to take plavix every day. Plavix is expensive so you have to make sure you have insurance coverage.  

Do you anticipate any surgeries in the near future? If you have surgery or out patient procedure where you may bleed, the surgeon may require that you stop taking plavix for a number of days before the surgery, increasing your chances of a heart attack.  I understand that there may ways around this problem, but you need to make sure your cardiologist will go to bat for you in this types of situation, i.e. he/she must be willing to work with the surgeon to figure a way around this problem.

If your cardiologist feels he/she stent can stent you, then I think that this is a very encouraging sign that it can be done.  Remember, we are not doctors on this forum. On the other hand, it is very important for you to feel comfortable about this whole procedure so it never hurts to get a second opinion.

Good luck!!

[Joed9]

I went in to have a heartscan just to appease my husband who had to have one for business.  I am 54 and we were shocked to find I have a 18.67 score putting me at 78.78% for my age group.  The 18.67 is in my left main.  I had a Cardiolite stress test which was normal but after discussion with the cartiologist I am having an angiogram next Wednesday.  I have no symptoms.  The cardiologist assures me the left main can be stented if there is a problem.  I am on aspirin, vitamins, and Crestor.  Is there anything you can tell me about stenting?  What questions should I ask? I had read you need to do a bypass for problems in the left main.  I am frightened and  feel pretty alone with this as I don't want to scare my children by talking about it.  I am at the "best' heart hospital in Indiana, should I seek a second opinion in Cleveland?

[Jack54]

You are most welcome. I hate to tell you this, but the area where your calcium score was 27, is the worst place possible to have a coronary artery blockage. Your left main branches off into the LAD and Left Circumflex, and most times supplies most of the blood to your left ventricle and the septum, or wall dividing your left and right heart, I think. IF the 50% blockage was referring to your left main, you really need to talk with your cardiologist and see if this test can be correlated to your stress test. Your stress test should show where your lack of blood flow (ischemia) to your heart muscle is located. I have left main disease also.


The left main taps off of the aorta, and I think that it is too large to stent. This is a very high volume of blood flow. I had a blockage that was partially in my left main but mostly at the beginning of my LAD. My local hospital wanted to bypass the LAD, but I had it drilled out and stented (rotoblational arthectomy) at UAB Hospital. This stent developed restenosis after 15 months (>80% closed) and I had the end of this stent stented again 3 months ago.

The good news is that you have a stable plaque, or one with a calcified covering. I do not understand why no one has described this to you....I feel like deleting this post, but......Anyway do not worry now because you are not having any symptoms. That should tell you a lot in and of itself.

I have never studied left main disease that much, but they have procedures for every type of blockage that exist. They perform miracles everyday. Getting depressed and worried will not help you at all. I have probably misinterpreted what your scan said, plus I am a tad off in the gourd :)

You are probably looking at a cardiac catheterization down the road, if you have a 50% blockage in your left main. I have had several and they are a piece of cake. No pain except for a tiny shot to deaden where they go into your artery. You feel nothing inside at all.

I may get run off after making this post, but hang around and you can cuss me real good.....

Jack

[jonjon49]

Hello Jack and Jilejam,lol let me explane how I ended up getting the 64 slice ct scane. I run daily.These last few years I havent felt like i did ten years ago, which is only natural I assume. I still have the endurence .In talking with my primary care physcian he advised me to take a strees test. During my stress test the cardologist questioned my being there only because I was on the treadmill for 16 or 18 minutes before my heart was in the state needed to adminaster the test. However, my test indicated Abnormal Myoview stress test .During my consultation with my cardologist  and after his review of my test results he felt my test had indicated a false positive ,after reviewing my options i chose to have the 64 slice ct scan .My test result findings are: Calcium scouring :Calciified plaque identified in the left main coronary artery yielding a score of 27.This places patient at the 70th percentile for age matched patients and is considered a moderate cardiovascular disease risk. Thank you Jack ,I hope all goes well for you and I am happy to see you going to the Cleveland Clinic what a great place for health care and Jill please consider paying for the ct scan it cost me 500.00  I think it would be well worth it for you  and I hope all goes well for you too .Thank you for your wonderfull and caring advice John

[Jillejam]

Sounds like you had the cadillac of heart tests....did your insurance pay for it?  I am in a battle to get this test done and paid for by my insurance company.  It sounds like you are doing all the right things for your heart, good food and exercise are the best thing you can do right now.  Don't worry about eating like **** and smoking in the past, you are doing it right now.  Jack is right about the 70% thing, they will probably just monitor you from now on to make sure you don't progress.  You definitely need to find out where the blockages are located, that is a big deal.  Also, the type of calcuim matters a lot too, just like Jack told you.  Your doctor definitely should know everything from that test you had done, doctors just don't give much info unless you press for it.  Good luck!

Jill

[Jack54]

You could do a search on average blockages for your age. The scan you just had is better than an angiogram, unless IVUS (Intravascular Ultrasound), in determining the type of blockage you have. There are stable plaques (have a calcified covering) and unstable plaques or soft plaques that do not have a calcified covering. These soft plaques are more dangerous because at any time they can erupt and cause a heart attack.

As we age, our arteries have progressive calcium buildup, that is not considered a blockage, unless it is really a blockage...So there are probably good statistics showing the average "calcium score" for your age. The scan you had should have calculated your calcium score.

Your specific blockages have less meaning unless you tell us where they are, and in which coronary artery they are located. A blockage in a small branch that is not critical in keeping the heart beating is not as serious as say the left anterior descending artery (lad). Most of us cannot survive full blockage of this coronary artery.

Coronary artery disease (CAD) can progress very fast or slow. I don't think that anyone can predict if and when your blockages will reach ~70%, which is a rule of thumb in flow blockage before they will stent a blockage. The artery also has to be big enough to stent.

I think in some tests, statins have been shown to reverse blockages. I think that Co Q-10 may also help. They have done some small studies that support this.

One thing is to take anti-platelet drugs such as Plavix and/or aspirin. It is good to take the combination I think, but the risk of gastrointestinal bleeding increases. Some studies have shown that aspirin alone protects against heart attacks and strokes as well as Plavix.

Take the omega 3 and 6 fish and flax oils. I am taking a prescribed form of these fatty acids known as Omacor. Copay is $25, lol. I take 2 grams of this and sometimes 2 more grams of otc fatty acids.

The FDA has stated that the ingredients in Cholest Off, and other otc type brands lowers cholesterol.

As one member here says, you can forget the past. There is no rhyme or reason as to why we get CAD. People with low cholesterol get it as well as people like myself with very high cholesterol.

Your blockages may stay the same for the rest of your life, but you need to listen to your body now. Learn about angina. It is our heart trying to signal to us that we may be close to a heart attack (mi). Angina is caused by lack of blood flow to the heart muscle.

Did you have a positive result on a stress test prior to the scan?

Good luck,

Jack