Coronary CT Angiogram

[Irshad51]

From Irshad Khan, New Delhi, India

I have taken last week CT Angiogram and its findings are worrisome. The main impressions are:

Calcium score:      18, Soft plaques seen in proximal LAD and D1 segment.

LEFT CORONARY ARTERY

LM   -  Normal

LAD   -  (Prox/Middle/Distal)-  Type -III LAD with normal course. Focal Eccentric non-calcified plaque seen with moderate luminal narrowing.

Diagonals----  
D1    -----   Single large D1 branch seen with normal course. Mid vessel reveal plaquing with moderate luminal narowing.

Obtuse Marginal Branches

OM1   --- Normal
OM 2  ---  Large OM2 artery seen with distal branching. Proximal vessel reveal focal luminal narrowing with approx  60-65 % stenosis.

Please advise me what course of treatment is advisable.

[ed34]

"And you said for vulnerable plaque bypass is not the solution"
Well, it would be difficult to decide where to bypass onto, if you can't see the vulnerable plaque beneath the artery lining. If you do opt for bypass, please make sure that the plan is good, because believe me, it is not nice going through all that discomfort for it just to last a very short period of time.

[nagrajjain]

When I find you have so many stents why my doctor did not put a single stent after my angiography and strait way told me about quadruple bypass surgery. My health is ok. Only my age of 71 years was of any problem I do not know. And you said for vulnerable plaque bypass is not the solution. Any way I will be going for third openion as and when time for will be suitable.Thank you all of you.

[ed34]

" If the demand by the heart cells for oxygen exceeds the capacity of the blood to supply it, then the heart undergoes ischemia and muscle cells can start to die"

And the worrying thing is that this can happen in a very short space of time. For example, if a pocket of vulnerable plaque erupts, this can float down the blood vessel and block it in a narrower section. The area where the plaque erupted from will form a blood clot so repairs can take place. The trouble is, platelets are not intelligent and don't realise when an artery is damaged all the way through the wall, leaking. They are simply signalled that the artery is damaged and automatically they block it, not realising it will kill you if there is no leak.
Some people have ischemia and feel no discomfort or symptoms, and so will likely suffer tissue death because no intervention is received. On the other end of the scale, people are in agony with pain.
Of course, if a pocket of vulnerable plaque is stented, it cannot erupt. The compression of the stent prevents this.

[ed34]

The blood inside the heart is not what gives oxygen to heart muscle. Blood is pumped out of the left ventricle, through the Aortic valve and into the Aorta (largest artery). Hanging off of this huge artery are the small coronary arteries which run along the outside of the heart. This is what feeds the heart muscle.

[curmudgen]

Heart muscle dies due to ischemia - the lack of oxygen to the heart cells -  not necessarily due to lack of blood, which of course, is the way it happens in most cases.  If the demand by the heart cells for oxygen exceeds the capacity of the blood to supply it, then the heart undergoes ischemia and muscle cells can start to die.  

[nagrajjain]

My doctor did not tell me anything more about colaterals. If you remember I have raised one philosophical question that how heart muscles die for lack of blood when heart itself is full of blood. Are there any other ways? I may recommend you change of doctor or second openion.