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Angiographic findings of my father
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Angiographic findings of my father

This forum is a very big help for people like us who dont know much about the subject. Firstly would like to thank all doctors who are helping us with thier inputs.

My father (age - 65) suffered a heart attack recently. Below are the findings from his tests -

Left Main - Normal
LAD  - 100% proximally cut off
Left Circumflex - 70% Narrowing proximally; OM1 - 90% Narrowing, OM2 - 60% Ostial narrowing
RCA - Normal

Pls note that he has already been put stent on LAD which was 100% blocked. However, the doctor also suggested that he must have other stenting done on Left Circumflex after 6 weeks (post 1st stenting)

I would like to seek advise on following -

1. Is the decision to put stent on LAD was correct?
2. Is it critical to have another stent done or this could be improved with medication?

Is it safe to wait for 6 weeks for further stent considering this condition (Left Circumflex - 70% Narrowing proximally; OM1 - 90% Narrowing, OM2 - 60% Ostial narrowing)

Appreciate inputs from practitioners.

Regards,
Vineet
9 Comments Post a Comment
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976897_tn?1379171202
My goodness yes, it was necessary to stent the LAD, it was totally blocked. This supplies a large amount of the heart. However, if he survived the ordeal, I would have thought it was being fed by collateral vessels which kept him alive. This vessel isn't nicknamed the widow maker for nothing.
His blockages will not improve with any current medications. They will remain the same. The only thing medications can do is alleviate symptoms. This includes lowering blood pressure, reducing inflammation of the arteries, forcing the arteries to dilate, lowering heart rate. Doing all these things can make life easier, but it doesn't in any way remove the actual problem.
Any blockage 70% and above should ideally be stented because there is a much greater risk in just leaving it. A plaque cap is holding all the sticky mess inside the artery wall, and if this plaque cap ruptures, then heart attack, stroke, death could result very easily. I should think that they will want to stent the 60% while they are at it.
Stenting is far less invasive than open heart surgery (bypass) and is lower risk, as well as a MUCH faster recovery. It took me a year to recover from bypass, it took me three days to recover from stenting, huge difference. There is also a much lower chance of infection with stenting over bypass.
Just glancing over the report, perhaps they will leave the 60% because it is an ostial blockage, which is difficult to stent. Your cardiologist will certainly give his views on this.
I do have a question for you too, did your Father suffer any permanent heart muscle damage from his heart attack?
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Avatar_m_tn
Thank Ed for your advise. This is very informative.

The doctor is recommending 2 more stents as far as i have understood.

Regarding the damage, we have been advised to wait for that information as this happened just 3 days back and doctor has called us for a follow up in a weeks time. I guess we will come to know soon.

Regards,
Vineet
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976897_tn?1379171202
The most accurate test for muscle damage is a nuclear perfusion scan.
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Avatar_m_tn
Thanks ed.

Can you pls also explain how is damage measured? and at what levels is it considered fatal / risky? i understand that with damage due to heart attack, the heart becomes weak and performance goes down.

Regards,
Vineet
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976897_tn?1379171202
Hi. Well it depends on how much damage has occurred. In many cases only a tiny piece of muscle is damaged, and it isn't the complete thickness of the muscle wall, only the top layer. However, if a large section is damaged beyond recovery, then over time the heart can go out of shape and have all sorts of problems. It depends really on the amount of damage, and how easily the remaining muscle can compensate for the loss. If it cannot cope because too much muscle is dead, then the ventricle will thicken the healthy muscle, then the ventricle will enlarge to the point where the wall becomes too thin to work efficiently, bringing about heart failure.
In some cases, heart muscle is thought to be dead, but it is simply damaged and most of it, if not all, can recover. However this can take a few months. A nuclear scan makes this very clear. It tags the haemoglobin with a radioactive isotope and this is absorbed into cells. If no isotope is absorbed into cells, they are dead. If a small amount is absorbed, then they are viable for recovery but still weak. It can also indicate another blockage causing the problem.
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976897_tn?1379171202
Oh my goodness, that wasn't very clear was it :(  let me try again. I was confused when I read it back.
A nuclear scan is only really useful when you've already had an angiogram to accompany it. If you imagine you can put tiny flags onto the oxygen in your blood and take images of where that oxygen is used in the heart, you can see which cells are healthy. If a group of cells doesn't contain any flags, then they are not using the oxygen, they are dead forever. Blockage or no blockage in this case, it's too late. Opening the blockage will not recover them.
Now imagine you see a few flags in a group of cells, much less than the rest of the heart. This can mean a blockage is preventing the flags getting there. This is why an angiogram in important. If there is no blockage, because stenting has been done for example, then the cells are in a recovery state, they were saved in time. They will fully recover over a few months, usually about 3 months. They have a lot of repairing to do.
With regards to the heart function with dead muscle, it all depends on 2 factors. The size and thickness of the damage, and how easily the healthy heart muscle can compensate for the loss. Heart damage is not always right through the thickness of the muscle wall, it can be in a thin layer. If the area of death is small, then the heart will likely be fine and compensate for the loss quite easily. If the extent of damage is large, then the heart will suffer long term. It will usually result in heart failure.

I hope that was a bit clearer :)
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Avatar_m_tn
Hi ed. There was some tech issue with my laptop and hence this delay in response.

Your response is immensely helpful in enhancing my understanding on the subject. We had a follow up with the cardiologist an he explained that there is 10% damage in functioning of the heart which soon may get repaired. Also, the stent is working fine. He suggested to wait for 4 weeks and then we will review what exactly to do with other artery (Left Circumflex - 70% Narrowing proximally; OM1 - 90% Narrowing, OM2 - 60% Ostial narrowing).

Thanks for all the help. ed.  Will kee in touch

Regards,
Vineet
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Avatar_n_tn
I am sorry but I do not agree with stenting a stable heart patient. If your father is stable after his heart attack and they did the angiogram and performed a stent there is no benefit of doing another angiogram to stent again.

Let me start off by saying a stent is NOT going to prolong life. The only time a a stent should be used if he is
1. Experiencing an acute heart attack.
2. Experiencing limiting symptoms.
I think too many patients are getting stents when they do not need them.

If he is symptom free after his heart attack then he should not be performing any more tests. He should also be on some medications now after his heart attack.

The best thing after his heart attack is to start a cardiac rehabilitation program. He should learn what he can do safely and effectively. Exercise will be his medicine. Making healthy food choices will be important and keeping stress under control.

Feel free to follow us on facebook.com/heartfitclinics

I hope this helps.

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976897_tn?1379171202
Interesting opinions and I keep reading comments saying stenting does not prolong life. However, no paper actually states what this really means and the context. Prolong means = extend the duration of. Nobody expects a stent to make you live longer than when your natural time arrives, so the statement is actually kind of silly. A stent isn't an elixir of life. Stents do save lives which is the important thing. If a patient is having an acute heart attack and will die, then they are stented and the heart recovers, hasn't their life been extended already from that point? Confusing concept to say the least.
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