I am 52 year old male. Yesterday my angiography was done. Following is the report. Kindly, advise me on what should be done next. My only symptom is heaviness in the left shoulder and occurs only after taking a meal followed by some form of exercise (mild eg.walking).
Left Coronary Artery
Left Main Stem: Normal bifurcating vessel
Left Anterior Descending Artery: Mild ostial disease and tight proximal stenosis followed by multiple tight stenoses in mid-distal vessel
Left Circumflex Artery: Long segment of severe disease in mid vessel. Fair sized second obtuse marginal branch is occluded in its proximal part and fills fairly late
Right Coronary Artery: Dominant vessel with moderate to tight mid stenosis
Good LV systolic function
Ejection fraction= 60%
Pullback gradient across LV-AO=55mmHg
You obviously have triple vessel disease, and some severe blockages in each one, the LAD, RCA and the LCx. Judging by the little activity you require to bring on symptoms, including digesting food, it looks like you need revascularisation sooner rather than later. Your LAD is diseased at the top and middle sections. Your LCx is blocked in the middle, the second marginal being blocked at the top. The RCA is your dominant vessel, and has disease in the middle section.
So, what to do next. The problem that you currently have is that the three major vessels are blocked significantly and this means there is no real source for sufficient blood flow/pressure to open natural bypasses called collaterals. If your RCA was not so blocked, then it is likely this would have formed a bridge across to the LAD, to help with feeding the heart muscle there.
I'm not sure what option your Cardiologist has mentioned, whether he recommends stenting or bypass. Looking at the amount of disease, and taking into account the number of vessels involved, I think they will suggest strongly you go for a bypass. They will likely graft 2 vessels to your LAD, one to your RCA and one to your LCx. Maybe they will also graft a vessel to the second marginal, but it's likely they will leave this and hope collaterals do the job.
My personal opinion is that something is done using intervention rather than just medication because all three vessels are seriously affected.
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