75% stenosis proximal RCA (Type B lesion)

[somy111]

Hi

My father (70+) was having trouble sleeping on side position due to pain in the arms. He was asked to do CT Angio and result is below.

Could someone what it sounds like ? does he need any surgery ?
He is feeling normal apart from arm pain when he tries to sleep on sides..

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Report:: : Clinical History: Asymptomatic, diabetes mellitus, dyslipidemia, TMT positive. ------------------- Procedure: ------------ Axial 0.5 mm thin CT scans were performed through the heart with ECG gating and 65 ml of intravenous non ionic contrast. Axial reconstructions were performed through RR interval. Systolic and diastolic volumes are studied. Three dimensional, multiplanar and curved reconstructions were performed through the coronary arteries are studied. Appropriate 3D images were made in to demonstrate the pathology. Report: --------- The coronary arterial calcium score is 533. The coronary arterial system is right dominant. The left main coronary artery (LMCA) reveals thin soft plaques with no significant stenosis and trifurcates into left anterior descending (LAD), ramus intermedius (RI) and left circumflex (LCx). The proximal LAD reveals calcified plaques causing 30% stenosis. Rest of the LAD reveals occasional plaques with no significant stenosis. The diagonal branches reveal no significant stenosis. Ramus reveal occasional calcified plaques with no significant stenosis and supplies the OM territory. The LCx is small and reveals no significant stenosis. The proximal right coronary artery (RCA) is dominant and reveals a thick soft plaques causing 75% stenosis. Lesion length – 15mm, normal vessel calibre – 3.2mm, minimal luminal diameter – 0.8mm. (Type B lesion). Distal RCA reveals eccentric calcified plaques with 50% stenosis. The posterior descending artery (PDA) ostioproximal segment reveals 60 – 70% stenosis. It bifurcate early and are small calibred. The posterolateral (PLB) branches is small calibred. Myocardium reveals no focal thinning.

CONCLUSION: - ------------------ - CT findings reveal 75% stenosis proximal RCA (Type B lesion).

dk NOTE : --------- The above modality is patient dependent. The study could be suboptimal if :- * Heart rate is high giving cardiac motion artefacts. * Patient is unable to hold his breath.  

[ed34]

What do you mean by a checkup? Another ct angio? If it's a case where the cardiologist says "how are you feeling" and your Father says "im fine thanks" then this is very inaccurate. A lot of various types of medication hide symptoms which are key to having a procedure. With a blockage of 75%, which is ABOVE the threshold of 70%, why don't they do it now and get it out the way? Imagine the outcome if it becomes 100% in those 6months and he has a heart attack. If the cardiologist tells you that blockages can't form that quickly, he is totally wrong. I had a zero to 99% occlusion form in my left circumflex in less than 4 months. My opinion is that with a straightforward procedure such as this which involves a single stent, why on earth ***** foot around.

[somy111]

Thank you both for your comments.

My father thinks he take the medication for  6months as suggested by cardiologist along with strict diet and go back for check up after 6 months.

Would that be a good idea ?

Does he need angiogram right away?

[Occupant]

If you call an "invasive procedure" surgery then, yes, he would need surgery. And as was said before an Angiogram would be the right choice.

[Ger57]

Hi,

the CT angio scan shows blockages in the right coronary artery that might be the cause of your fathers pain in his arms. Unfortunately the CT scan gives only a rough indication of the severity of the blockages and the effect of them on the blood flow in the coronary arteries.

For a more accurate diagnosis, a heart catheterisation would give the most reliable results. This could be the next step.

Do not think of surgery yet. It could very well be that the condition can be controlled with medication only or by placing a stent at the position of the relevant blockage.