My father recently displayed symptoms of a heart attack. When he went to the doctor they determined by CT scan that he had had a heart attack but it was probably 1 1/2 years ago. They said it "killed" the lower portion of his heart. They then did a heart cath. to check blockage in the right artery. They said he had 100% blockage and "the artery is gone". They said it was too late to do anything for it. He had angio on the left artery 2 years ago and said it was still good. Then they showed pictures illustrating that the left has 40% blockage in one area, 20% in another and a small plaque deposit in another. His cholesterol has been great since the angio. 2 years ago. Last week his bad chol. came back at 54. Where did the blockage on the right come from? Why can't they do Bypass? They gave him no restrictions but he has started heart rehab excercizes. His function is 40% and they act like it's not a problem. Can he survive without the right artery? Why wouldn't they do angio to free the 40% and 20% blockages?
It sounds like the right coronary artery is completely blocked and the tissue it supplies is completely dead. Therefore, there would not be much point in bypassing an artery to supply tissue that is already dead. The 40 and 20 percent blockages are not considered severe and are never treated with angioplasty or surgery, just with medications. Yes, he can continue to live with out his right heart artery, as it has already done as much damage as it can, and should not cause any further problems in and of itself.
I am 50 years old and also have a longstanding 100% occluded RCA. There is some myocardial damage immediately below the blockage, but my ejection fraction is still 70%. My cardiologist says that there is about a 20% of normal blood supply being provided to the bottom right portion of the heart by collateral arteries which have developed over the years.
In my case, the blockage couldn't be fixed with angioplasty, because my cardiologist was unable to enter it. These blockages can be bypassed with either CABG or minimal invasive bypass. There is some debate as to whether there is any advantage to bypassing a 100% occlusion in the RCA. My layman's reasoning for not having it bypassed, was that the damage was already done, and that a bypass operation involved too much risk and physical stress for the benefit of supplying scar tissue with a healthy blood supply.
I have made a lot of diet and lifestyle changes and lost over 30 pounds since last winter. I walk fast for an hour every day and hike or ski at least one day every weekend. I have slowly built up a very strong endurance and can hike up and down 5'000 feet in a day, but I don't run or do strenous exercise which maximizes heart rate. I am also on 40MG of Pravachol for cholesteral reduction.
The only concern that I have about not addressing the RCA blockage surgically, is that perhaps this will contribute to eventual heart failure sometime in the future.
The heart is an amazing machine, i usued to work in a cardiovascular lab, and we had a cath that was just amazing to me, i was not present to the actual cath, but a coworker showed me the films...a totally occluded left main artery, nothing was left but a stump, it was really hard to believe that that patient is alive and more or less fine, his right coronary, fed the left ventricle with collateral ateries.
The situation is actually quite complex and needs to be individualized. My feeling is, in general, that if a right coronary artery is completely blocked and the muscle it supplies is completely dead, there is no point in opening it up. However, it is actually possible that the tissue is not dead, but just hibernating, in which case opening it up may be helpful, for improving heart function or relieving angina. Also, whether or not other arteries are supplying the area that the blocked artery is supposed to supply is an important factor. Thus, the decision to open an old blocked artery is not always an easy one. However, with your normal EF, it would be hard to think that opening up your blockage would help in any way. If the blockage has not led to heart failure yet, I doubt it will.
That is a very unusual case and a very lucky patient. Left main occlusion almost always results in sudden death. Hoopefully that patients right coronary artery will not close down.
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