Coronary Heart Disease.

[mistertalented]

I am 38 years old and live in Mumbai India. Recently I had an MI and I went for a Coronary Angiography (CAG). The findings are as follows:
Clinical Diagnosis: IHD
Technique: Retrograde left heart catheterization performed through right femoral artery. selective left and right coronary angiogrphy. LV angiogram performed in RAO view.
Left main: Normal.
LAD: Moderate sizwed type II artery. It is 100% blocked after D1. D1has 90% osteal stenosis. Bridging collaterals opacify mid LAD antegradely.
CIRC: Is moderate sized non dominant artery. It has 90% proximal disease. OM has 90% mid segment lesion.
RCA: Is moderate sized dominant artery. It has 80% osteal stenosis. Collaterals to LAD are seen.
LV Angio: LVEH= 0.55%. No regional wall motion abnormality. No MR/MVP.
I am also positing in my Two dimensional Echocardiography and colour Doppler Study which basically has the following conclusions:
1) Normal sized LV with mild hypokinesia of inferior LV wall. LVEF appears 50% Mild diastolic dysfunction present.
2) Trivial Mitral regurgitation. Rest structurally Normal valves.
3) RV is normal sized with good contractility. RA and LA are of normal size.
4) Intact IAS/ IVS.
5) No clots, vegetations or pericardial effusions noted.
I would like to have your advise in the above condition. I am willing to send my CD to your institute. I am also willing to offer myself for innovative technics(preferably non invasive) for experimentation.

[CCF-M.D.-CRC]

Dear mistertalented,

Based on these results probably your best option is to go for bypass surgery.  This is severe coronary artery disease in someone who is quite young.  In addition to surgery you need to drastically modify your lifestyle.  If you are smoking you must stop.  You need to discuss with your doctor changes in your diet and other healthy changes.

We do sometimes do 3-vessel angioplasty (minimally invasive ballon dilation) in persons who cannot undergo bypass surgery but if you were to come here we would likely recommend surgery.

[mistertalented]

Thanks for your response. I was hoping that latest tecniques in angioplasty such as sirolimus coated  stents which would minimise the risk of restenosis could be used to avoid CABG. Besides this are there any other techniques which are available to avoid CABG???

[No Bypass / No Stents]

It just goes to show that the heart will build collaterals in younger people with sever disease.

I have about the same severity of problem that you have.  I have a 100% occluded RCA, which has been that way for years, but has developed good collaterals over the years.  

I have a ostial occlusion of about 90% of the circumflex, which can't be stented.  My last attempt at angioplasty was aborted because a large plaque in my left main had ruptured and the remaining shoulders of it were flopping back and forth in the strong current.

So basically that's about as bad as it gets.  Of course the attending cardiologist gave me the sudden death sales pitch for bypass surgery when I was flat on my back.  I told him that, since I hadn't died when the left main ruptured, I doubted that I was going to die in the near future.

Anyway I have lived a pretty normal physical life since my last heart attack.  I hike, ski, and climb.  Last summer I did three extended backpack trips with 55 lbs on my back for 8 hours a day.  I climb a 12,000+' mountain here in Washington State every summer.

But it's highly probable that if we don't change the conditions that caused our disease we will die an early death.  If not from sudden death, eventually from heart failure.

In someone with as severe as disease as you have at your young age, if it's not heredity, I would treat first for a bacterial cause.  There wasn't any literature on dosage at the time that I did it, but I took a very strong antibiotic, Zythromax, for a month in hopes of knocking any Clamydia (chlamydia) Pneumonia bacteria from my plaques.  I have since learned more and would suggest a 3 month round of

Next, you have to treat your cholesterol extremely aggressively.  You need to get your total cholesterol below 150, ldl below 90, and HDL about 50.  You didn't mention it, but I would bet that you have extremely low HDL like I did.  I raised mine from about 30 to 48 so far and lowered my TC from 220-240 to 141-156.  Hopefully you have a good liver.  A Statin is a must to such the lipids out of your arteries.  Lipitor is best of breed and twice as effective as most of the others.  I also suggest 1.5 to 2 grams of Niacin before bedtime.  If you can't get used to the flushing, get prescription NIASPAN.  I also take a newer bile binder called Welchol.

Second, you have to control blood pressure, and should be on an ACE inhibitor to reduce your risk of another heart attack, even if your BP is normal.  I take Ramipril + Norvasc.

The third leg of my treatment program is daily walking.  I walk a hilly course for 35 minutes before work and before lunch.  Walking on the flat isn't enough.  If you have angina, push up to it, but not through it.  If it hurts, you are setting yourself back.  Slow warmups and don't exert yourself after eating.  Especially after having a heart attack, you need to be very careful, but you need to exercise and do more progressively.  But you don't want to do further damage.

Fourth, you need to get the saturated fat out which is mainly meat and dairy.  I do as much as I can, but depend on the drugs to do the rest, because I am pretty much on an eat, drink, and be merry program.

Also, I take some basic Vitamins and Supplements.  I dring a liter of low sodium tomato juice every day and try to eat some fruit each day.

Another area of course is reduction of stress.  I practice minute to minute attitude adjustment when necessary.

Things not to get sucked into: Beta Blockers, Blood Thinners, and Nitrates.

And remember that Bypass surgery doesn't stop your disease.  At your age you could be hosed up again in a few years.  Also remember that stents are forever.  You will never heal that artery with a stent in there or a bypass.

If the heart attack didn't kill you, you probably won't experience sudden death.  You will likely die in 10 to 20 years of heart failure, if you can't stop the disease.

Remember that it took you 20 or 30 years to walk into the woods and you can't walk out in a couple.  I am treating my disease as a chronic condition, living normally, and trying to stay even with it,  In 5 years, I hope that I will have a good amount of reversal.  I really don't think that my prospects would be better with bypass surgery.

Good Luck.

[No Bypass / No Stents]

The antibiotic most currently favored is Clarithromycin.

The dosage used in the study was 500 miligram per day for 85 days.

<A href="http://www.heartcenteronline.com/myheartdr/home/research-detail.cfm?reutersid=2413"><A href="</A>

There is a chance that your disease is caused by Chlamydia pneumoniae or another bacteria.  Some day they will have vaccines for this.

Good Luck.