Blockages

[Joe__0__0]

  Hi Doc:
  Last week I told you that I was going in to have a caterization and a possible stent placed.  My cardiolgist found that I did not require a stent or any angioplasty.  His discovery was that a small vessel off of another small vessel had a 100% blockage and that another small vessel off an artery had an 80% blockage.  He further stated that of the 3 main coronary ateries 2 were clear and 1 had less than 50% blockage.  He also noticed during the caterization that collateral vessels were appearing.  The following day I did an echocardiogram stress test.  These result showed the same as the thallium stress test that after 5 minutes upper chest near shoulder pain and a skip in the heartbeat.  I remained on the treadmill for 12 minutes but noticed that the pain was getting better instead of worse and the technician also noticed that the skipped beats were not as frequent.  Before all these tests I was on atenelol 50 MG.  Now I have been given an additional med called Norvasc 10 MG per day.  My question is that I have been placed on minimum exertion and I am wondering how long does it take for these collateral vessels to replace the blockage and to what percentage to they supply the neccessary oxygen under exertion.  I have also heard of a treatment called Enhanced External Counter Pulsation which is suppose to create more and stronger collateral vessels.  Can you enlighten me as to whether my heart will continue on its own to bypass this blockage by these collateral vessels, how long would something like this take and to what percentage point of the original vessel.....and is this EECP something to look into for quicker results of creating collateral vessels?  All of these blockages are in the lower part of the heart.
  Thanks again for your assistance.
  Joe

[CCF Cardio MD - MTR]

_
Dear Joe, thank you for your question.  If your three main coronary arteries have no significant (stenosis > 50%) blockages, then your prognosis should be good.   The smaller, branch vessels that were found to have significant stenoses are too small to be treated with angioplasty/stenting, but could still cause you to experience chest pain.  Thus, medications are the way to go.  Norvasc was probably started to improve blood flow to the areas of the heart muscle served by the blocked branch arteries.   This should help to relieve your chest pain in turn.  Collateral blood vessels from to "auto-bypass" blockages in coronary arteries.  Since your blockages are in small arteries, collaterals are not as important. There is nothing in particular that you can do to increase the number of collaterals that you have, but you should practice a "heart-healthy" lifestyle including daily exercise, a low-fat diet, and avoidance of tobacco and alcohol.  I don't know why you were placed on light exertion, so ask your cardiologist about that.  EECP is not a proven treatment and involves wearing a cumbersome device over the pelvis and legs that vigorously contracts via a hydraulic pump system.  Thus, it is uncomfortable and no studies have proven that EECP is an effective treatment.  Therefore, I suggest that you save your money and stay away from EECP.  If you following the previous advice and take your medications regularly as prescribed, you should have a good prognosis.  
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.  Good luck!
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