Coronary Arteriography

[medepressed]

Sir I just had a coronary arteriography and and the results are'
Left Coronary Artery
Left Main Stem:calcified, trifurcating vessel with moderate distal disease.
Left Anterior Descending Artery:proximal part is calcified, moderate proximal disease followed by subtotal mid occlusion.
Left Circumflex Artery: lage, dominant vessel with mild proximal disease followed by severe disease in distal part before origin of LPDA.First obtuse marginal branch is fair sized vessel with moderaley severe proximal disease.
Ramus Intermedious Artery:sizeable vessel with moderate proximal disease.
Right Coronary Artery:small, non dominant vessel with moderate proximal disease followed by subtotal mid occlusion.
LV Angiogram:Hypokinesia of anterolateral and apical segments.
                      Fair LV systolic function.
                      Ejection fraction 50%.
Sir' kindly tell me what this all means & please explain how many vessels disease I have, what percentage of disease is there' and what should you advise in this scenario because I am a patient of Diabetes and Hypertension' If my Doctor advise me CABG' Can I delay that for few months? My age is 54 years male.Can angioplasty be done in this scenario?.
Thanking you in anticipation.

[Cleveland Clinic]

There is severe disease in the LAD and the LCX (this is a dominant vessel) making your scenario essentially triple vessel disease.  In the setting of DM, CABG surgery is the best option for you.  I would not even consider angioplasty and stenting because total revascularization is absolutely necessary in this situation.  There is also better long term survival with CABG vs angioplasty because of diabetes.  As long as your symptoms are controlled with medications you could delay the surgery for a couple of months, but don't plan on any trips or major events.  

[Healthyself2]

It sounds like you have difuse vascular disease.  10 years ago I was faced with a similar situation.  Totally blocked right coronary artery, some abnormalties in the LAD, a 90% occlusion at the start of the circumflex and later a ruptured plaque in my left main.  I consulted with a surgeon after my first failed attempt at angioplasty and decided that I just didn't feel that bad.

I read some research going on at the time where the progression of coronary artery disease was being stopped and even regressed with the newish statins when combined with other drugs.  I opted to try agressive cholesterol and BP therapy with eventually 3 cholesterol drugs and 2 BP drugs.  For the last ten years I have maintained a perfect lipid profile via these drugs.  Most importantly I raised my HDL from around 30 to consistently in the mid 50's.

I also improved my diet, eating more green stuff and started doing long duration mildly aerobic exercise - in my case hiking uphill.  After a while my ability improved to a point where, one summer, I was hiking 10,000 feet of vertical every week.

Unfortunately in the last few years I have reverted to some of my old bad habits - too much alchohol, overeating a mostly fat diet, and less exercise.  Still, what I did back then must have saved me.  Sunday I went out and hiked a modest 1,300 feet of elevation.  Today I did the same, but walked 9 miles in the process.

At this point I feel that the disease might come back to get me, but it will be my own fault if it does.  The program did work and I had 10 good years with no further cardiac events.

After my plaque ruptured in my left main the docs really tried to scare me into CABG again.  They said that it could reform and kill me.  I ask them, if that was so, why didn't it kill me the first time it broke?  Anyway they looked at it one way and I looked at it another.  I saw the rupture as the result of this plaque being dried out because of the cholesterol therapy and the remaining cap just coming off from the hydraulic pressure within the left main.

After you have your CABG, you will still have all of your disease.  The alternate way is to treat the root causes of the disease.  Since it hasn't killed you as of yet, your risk will be continually lowered as you reduce the factors which got you to where you are.

[oldie]

Hey, hey. You're what I'm looking for. I 'm 81. Echocardiograph (or 'gram') 'suggests' CAD 'probably' triple. My  cardio gave me three alternatives: medication alone, meds+ stents, meds + bypass.He pushes for bypass.  I plumped for meds.  I take propafenone 150/day,a betablocker (Coreg), aspirin, a natural composite of omega3, B vits etc, one for HBP which I don't have.I have just added niacin for  low FT3. I have a strict meditterranean diet.  I can be sick as a dog eight or ten times a month -nausea, fatigue, imbalance, head consttriction  but no chest pain -   but  sick or not I do 5km fast daily on a bike with deep breathing on the slopes but never gasping. Six weeks now.What do you say I keep going like this'?
I'm also on thryoid drugs but won't touch  on that if you don't have amiodarone induced . hypo, too. I'd be royally grateful to hear from you.

[Healthyself2]

I don't know about the propafenone, but the Coreg is probably what's making you sick with the symptoms you describe.  I think what you are suffering is near syncope due to the beta blocker.

As far as the CAD goes, if it didn't kill you until the age of 81, your heart has adjusted to it by making it's own bypasses and it's not likely to kill you if you can stop or reverse the process.

It's not necessary and probably not wise to do intense aerobic exercise.  The best exercise is long duration mildly aerobic, let's say that get's your heart rate up 30-40% or so..

The goal should be a healthy vascular/endothelial system rather than worrying about a few calcium artifacts in your coronary arteries.  If you can tolerate a statin, take one.  If you are not an alcoholic, drink a glass of red wine every night.  High dose niacin (not the no flush kind) is stil the only thing on the market to raise HDL.  Your HDL is the main predictor of longevity.  Eat more green.  The omega 3 is very important - that's even mainstream thinking now.  Keep those plaques dry.  Even a 90% plaque can't hurt you if it's dry.  

When I first started, the medical profession sold CABG by telling you that it was the amount of vascular constriction that killed you.  A few years ago and several million CABG surgeries later, they found out that wasn't true.  It is the contents of a ruptured plaque which form the clot that damages your heart of kills you.  Keep the plaques dry and they are of little consequence.

Good luck