70% blockage on the mid LAD

[jlanda]

one year ago i was dignosed with a 70% blockage on the mid LAD, mi cardiologist said me i needed a cateterization but i refuse and went for medications and lifestye changes. i dont have any symptoms even during exercise i do one our per day. Nevertheless, i still worried about my condition and I need to know for how long time can i continue with medications only or if its better go for the cateterization, and thus avoid a possible heart attack in the future.
thanks

[Occupant]

That still does not answer the question, where does the number of 70% blockage come from? I had a CT-Scan six years ago showing an Agatston score of 783. I didn't do anything until the end of last year and had an Echo done showing normal function of the left Ventricle/Atrium. Of course, I could have developed collaterals to take care of the reduced blood supply, but I doubt it.

[jlanda]

Hello occupant, the 70% blockage  It comes from images of the coronary arteries taken during the ct scan (I asume from visual calculation of the dr). With regard to the calcium score of the study, it resulted in 13 in the RCA.

[Ger57]

The problem does perhaps not require immediate attention. but the question is what is best option for the long term.

If you absolutely do not want catheterisation, the case is clear. You continue with your current lifestyle/medication and future will tell if problems arise or not.
You say you felt some chest pains in the past. If they return and/or get worse, you need to contact your cardiologist.

If catheterisation is an option for you, a good indication of the seriousness of the blockage can be given.
I do not know how the situation is in your country but in the Netherlands catheterisation is done almost routinely and placement of a stent can be performed during the same procedure.

[jlanda]

Thanks for your comments have been of great help to me, it is difficult to take decisions in this situation as you say mainly with respect to the long term. I have also heard that in many cases the site where the stent is placed can be occluded again and even need more stent or open heart surgery. Well thank you very much again and I hope everything goes well for you.

[Ger57]

Yes, occlusion can happen although this is rare with the newest types of stents.
Take care,
Ger

[Ger57]

Why did you have the stress test, if you had no symptoms at all?

If the finding of ischemia during the stress test was an isolated finding, you could argue that it is an error, but together with the CT outcome, it is very probable that under certain circumstances your heart does not get enough oxygen (even if you do not notice it).

You do not mention how severe the ischemia during the stress test was, and if it appeared only at maximum effort or already at lower exercise levels.
You can imagine that it can happen during your daily activities without you noticing that you heart is suffering.

Ischemia without symptoms is called silent myocardial ischemia and is not harmless. It can cause arhythmias and lead to heart failure.

Why do you object to a catheterisation?

[jlanda]

hi thanks for your comments, a little background, i went for the stress test because every day I was feeling small chest pain, which lasted no more than 1 minute. Then I did the stress test which came out positive of ischemia, I did thirteen minutes on the treadmill without any problem and without presenting any symptoms and the ischemia appeared only in the recovery stage. After this i made changes of lifestyle plus medication and chest pain disappeared after two weeks and to date I have not felt it again and no other symptom.

there are some  results of the estress test:

-Ischemic changes of reperfusion without symptoms are shown.
-Ekg basal: flat T-waves.
-ST Depression on DII, DIII, and aVF, V3 and V4.
-The theoretical oxygen consumption is 53ml/kg/min.
-The work performed represents an energy cost of 15.2 Mets.
-The effort performed equals 106% of the maximum oxygen consumption (Vo2 max).
-Maximum frequency reached during test 202X’, equivalent to 116 ‰ of the maximum frequency for the patient’s age (174x’).
-Duration of the test thirteen minutes.
-Modified index of sarnoff increase 2.6 (double final product in relation to rest).

[jlanda]

I forgot I do not want catheterization unless it is strictly necessary because of the risks involved in the procedure. Additionally seek the opinion of another cardiologist who told me that it was not an emergency to perform the catheterization and that for now I would continue with my treatment. But I would like to know that it would be the best.
thanks

[Ger57]

With a healthy lifestyle and taking the prescribed medication, the blockage may progress very slowly or even not progress at all.
So if you have no symptoms, your choice is quite logical.

How was the 70% blockage diagnosed? Normally this is done with a catheterisation procedure (angiogram).

[jlanda]

thanks ger57 for your answer, well one year ago a made a stress test that show miocardial  ischemia. since that the doctor said me about the cateterization, but i went for medication and lifestyle changes. so i forgot mentioned that in january of this year a made a CT scan In which I have diagnosed the 70% blockage as a consecuence of this result is that I am worried, Because before it only knew the ischemia but not of the percentage of blockage of the artery.  can i continue alone with medications and regular checkups with the cardiologist?
i no have symptoms at all and i feel great, but very worried.