Chest pain and Diagonal Branch blockage

[Vlada]

I am 51 years old male. I was reasonably active (I walked at least 60 minutes 3 times per week).
About two months ago I waked up one morning with the chest pain (at rest). I had problem to walk 50 meters (even slowly). I went to hospital and they excluded heart attack.
I had to wait almost the whole month to do exercise test and in the meantime my condition improved although I still had chest pain especially when walked fast.
I did exercise test and after 9 minutes (standard Bruce protocol) I had to finish test because of chest pain. ECG showed 1.5 mm ST depression.
After that I did coronary angiography with the following results:
Diagonal Branch (on LAD) more than 90% blocked, RCA 40% blocked and LAD 30% blocked.

Questions:
1 - Would it be the best solution for me to put the stent into my blocked Diagonal Branch artery?
2 - How big risk would be if I do NOT put the stent into my blocked Diagonal Branch (ie. is it life threatening taking into account that main arteries are not blocked more than 40%)?
3 - Could be my heart muscle permanently damaged if I do NOT put the stent?
4 - Is it risky for me to exercise/walk? (Just to mention that in the last few weeks I walk about 6-7km every day, distance is not a problem, but if I walk fast I am getting chest pain)?
5 - Would it be possible that my angina improves if I do NOT put the stent (by using medications, diet, exercise)?
6 - Could be the plug rapture the cause of my sudden angina and my Diagonal Branch blockage (as I said my angina did not develop gradually)?

[Cleveland Clinic]

Vlada,

Thanks for the post.  

1 - Would it be the best solution for me to put the stent into my blocked Diagonal Branch artery?

If you are symptomatic from the blockage and it could be safely approached with a stent it is a perfectly reasonable option. Sometimes stenting the diagonal branch can compromise the LAD and this would have to be taken into consideration.

2 - How big risk would be if I do NOT put the stent into my blocked Diagonal Branch (ie. is it life threatening taking into account that main arteries are not blocked more than 40%)?

The blockages that cause a heart attack are often different then the ones that cause angina. Often the 40-50% blockages can rupture. There is no known benefit of stenting these blockages.  For you the main negative issue of not treating the diagonal woould be continued angina.

3 - Could be my heart muscle permanently damaged if I do NOT put the stent?

Impossibe to tell. There certainly is a chance given that you are having continued symptoms reflecting poor blood supply. The amount of muscle supplied by a diagonal is variable -- some diagonals are huge athers are small. This is also a factor in choosing whether a stent should be placed.

4 - Is it risky for me to exercise/walk? (Just to mention that in the last few weeks I walk about 6-7km every day, distance is not a problem, but if I walk fast I am getting chest pain)?

Generally not. THrough conditioning you may even be able to improve the amount of exercise you can do without getting angina. However, this should be done under the supervision of your physiician.

5 - Would it be possible that my angina improves if I do NOT put the stent (by using medications, diet, exercise)?

Very possible, as long as your angina doesnt prevent you continuing to maintain your fitness.

6 - Could be the plug rapture the cause of my sudden angina and my Diagonal Branch blockage (as I said my angina did not develop gradually)?

Perhaps. its impossible to know. But the contrinued angina is most likel due to hemodynamic limitation from the current plaque.


good luck

[mend]

This is the first post that is very similar to my problem.  I also have diagonal branch blockage off of the LAD.  Four years ago I started with symptoms while exercising.  They did a cath and found 50% blockage in the LAD and 70% in the branch.  I was told at that time it could not be stented because of compromising the LAD.  I continued getting angina while exercising, but used the Nitro patch.  I did the treadmill for 40 mins. and lifted weights.  The problem I have now is the angina has gotten worse, and I can not longer exercising at the speed I was doing.  They did another cath and the blockage is now 60-70% blockage LAD and the branch is 85%.  I also have 3 lateral at 60-70% blockages.  I have now been told that I need surgery because of angina.  They have also used the word ischemia too.  I ask why surgery because blockage are not that bad and was told that angina is the important subject.  The dr told me that 50%   of the heart attacks do not have a lot of blockage.  I am a thin woman and in good health except for the blockages.  I still exercise, but at a very low speed for me.  I have been told that I could have a heart attack and should do the surgery.  I have not made that decision yet. If I can answer any questions for you, please let me know.  I did not go into the entire situation on this post.  It is somewhat long.