Angiogram result

my father in laws Angio results

LMCA - distal LMCA 70-80% stenosis
LAD - disease from osteum tomid venel. tight multiple stenosis 95%
LCX osteal 99% stenosis proximal 80% justafter high om1
            -om2 osteal 80%  mid vencl 70%
              om1 & om2 graftable
RCA dominant . proximal cto & bridgins co laterals
         diffused TVD

he had a stroke in 2007, have severe throat pain ,
just want to get an idea on is this related to heart valves or muscle arteries.

[ed34]

throat discomfort can be a symptom of angina, I get it often as do many others. The stroke could also have obviously been caused by the disease. His LAD and LCX look quite bad. Have they recommended what should be done with those two vessels?

[kenkeith]

When the word angina related to the heart is angina pectoris.  That usually is chest pain, and sometimes radiating pain to the neck shoulders, and back.  Throat discomfort is usually a burning sensation and sometimes mistaken  for GERD (digestive disorder).

Angina related to the throat is an acute inflammation of the mucous membranes found in the throat, which can infect the tonsils with streptococci. This is most often diagnosed in young individuals. Angina can be treated with antibiotics and penicillin.

The pain related to the throat could be due to the thyroid gland, and my doctor always checks for any inflammation or growth on the throat.  It could be related to cancer, etc.  Your father-in-law should have the doctor rule out anything serious.

QUOTE:"just want to get an idea on is this related to heart valves or muscle arteries".

>>>>There is no apparent or indication of any valve disorder. Any lesions greater than 70% can be problematic, and your in law has extensive coronary valve disease.  Was the artery evaluation made with a cath or was the angiogram CTscan or MUGA.  It seems if the angiograph with a cath there would have been stent implants in the areas of major occlusions?

Thanks for sharing, and if you have any followup questions you are welcome to respond.

[cham73]

thanks for the comments,
he was diagnosed few months ago as congestive heart failure, he had throat issues for few months which many doctors couldn't diagnose.(including  ENT) ultimately after a chest CT scan diagnosed as fluid in his lungs.  
his cardiologist mentioned soon after wards that due to his weak heart, a bypass (CABG)  is too risky. but eventually did the angiogram.
apparently this was done with cath (he said a cable was inserted in his leg) and said to be stent was not possible.

(unfortunately his regular cardiologist is not available for few weeks due to some illnesses and we need to switch to a new doctor.)

[ed34]

"Angina can be treated with antibiotics and penicillin"

really?

[kenkeith]

Many years ago I had congested heart failure (fluid in the lungs...edema), and CABG was ruled out to be a risk, not life or death necessary, and surgical intervention for totally occluded LAD was not done and unable to stent as well (sometimes a totally occluded vessel can be stented).  That was about 7 years ago, and today my heart pumps adequately, and collateral vessel seems ample enough to supply enough blood to deficit locations.

The RCA dominant is a vessel configuration, if I remember correctly, it  has a vessel configuration that feeds into the left side that may account for blood perfusion to a deficit area and provide relief.  Also, the test mentions collateral vessels and that may be a favorable consideration as well.
_________________________

Ed, I assume you were referring to angina pectoris.  For years I always made a distinction by identifying chest angina with angina pec to avoid any misunderstanding.  I related to inflammation of the mucous membranes of the throat, and merely making a distinction of the chest pains related angina pectoris, GERD, burning sensation in the throat, etc. and throat  pain association with an infection throat membranes.

Vincent's Angina ia an acute necrotizing infection of the pharynx.  Sometimes called Plaunt's angina.

Pseudomembrane Angina,  type of inflammatory response characterized by the production of mucus, which adheres to the adjacent conjunctiva. This differs from a true membrane in that the latter is firmly attached to the conjunctival surface and is composed of dead cells and debris.

[ed34]

Yes I was discussing Angina pectoris. I have suffered the throat discomfort since 2005 and it occurs only on exertion. If I persist and ignore the pain in the throat, which is very hard, then chest pains follow. In effect, it's an early warning system for me and apparently not uncommon. I hope this explains what I was referring to :)

Dominance is usually determined by which side feeds the posterior descending artery. If the Left circumflex feeds it, you are left dominant. If the right feeds it, you are right dominant, and if both (like myself) you are co-dominant. Around 70% of people are right dominant, 20% are co-dominant and 10% are left. That's my understanding anyway.

[kenkeith]

You are correct, angina related to an ischemic heart vessels would not be helped by antibiotics, etc.  I haven't had angina so I am basing the symptoms on what other people have experienced as well as written descriptions.  I have never heard of heart related angina causing severe throat pain.  I know there can be radiating transfer pain to the arms, shoulders, back and neck.

I became interested in the vessel configurations and the different patterns with left, right and equal dominance, when I had hypokinesis, heart failure, and moderate to severe MVR.  Depending on the configuration, the papillary muscle may be more vulnerable, and papillary muscle supports the cords that attach to the leaflets, and it can be feed by the LAD and circumflex.  I have a totally occluded LAD and 72% circumflex lesion. There may been irreversible damage, but according to the doctor sometimes MVR can be reversed...it didn't happen.

[ed34]

When you say a totally occluded LAD, are you saying that the LAD has a 100% occlusion (blockage) but there are collateral feeds to some extent? I assume there must be some feed through the LAD or your left ventricle wouldn't be working, would it?
Is your 72% restriction in the left Circumflex around the Obtuse Marginal 1 area? I am intrigued why some areas of coronary arteries seem to block so commonly. It seems to be the OM1 area of left circumflex, Proximal section of LAD and the middle of the RCA just before the Acute Margin. I can't help but wonder why those areas are so common.

[kenkeith]

It seems I have a totally blocked LAD as the report states, and a stent cannot be done.  That was more than 6 years ago, and the technology may have changed and/or the cardiologist  lacked the skill at the time.  A ct scan 2 years ago states "the first diagonal branch is a large vessel that has a modrate so severe degree of calcified plaque in its ostial course and the mid course has soft calcified and non-calcified [laque with moderate degree of stenosis..  The LAD appears to be completely ocluded in its proximal course"....the circumflex also appears to have significant plaque...the large marginal has a non-calcified plaque of moderate degree, in its proximal course followed by severe plaquing in mid course...


My notes state hard plaque causes the artery walls to thicken and harden. This condition is associated more with angina than with a heart attack, but heart attacks frequently occur with hard plaque.

Soft and unstable. Soft plaque is more likely to break open or to break off from the artery walls and cause blood clots. This can lead to a heart attack.

In atherosclerosis, plaque deposits build up in the arteries. Plaque is made up of fat, cholesterol, calcium, and other substances from the blood. Plaque buildup in the arteries often begins in childhood.

The way I understand, it is a bifurgations have maximal turbulance and mechanical stress on the vessel wall.  This would  be consistent with blood flowing under pulsatile pressure, and this mechanical pressure and turbulence, over time, causes little stress cracks in the vessel. The cracks appear at sites of maximal stress.  The coronary arteries are under addition stress due the extra motion of the cardiac muscle which moves and stretches the coronary arteries every heart beat, especially as the arteries branch off from the aorta which is relatively stationary, while lower down over the surface of the heart, the vessels move vigorously with each heart beat.  Bottom line hard plaque is essentially the net result of the healing process for these little cracks in the arterial wall resulting from mechanical stress.  Does that square with your observation where most occlusions occur?  Proximal section and mid section of an artery may have some vigorous activity, and a bifurgation can cause turbulance of blood cells.

[ed34]

yes it does make perfect sense. The bifurcation of the LAD and Left Circumflex is certainly a very common place. I suspect with the particular cell structure of the bifurcation, the Promimal LAD must be weaker in that area. I should also think in microscopic terms there is a lot of tugging on the bifurcation of the Acute Margin/RCA causing stress points.
Do you think some people heal those fissures a lot quicker than others, to help prevent atherosclerosis? It makes me wonder if people performing far more physical activity are actually at more risk. It certainly shows how stress pays an important role in the disease.