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Diagnois explanation
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Diagnois explanation

what is  meaning of of these conclusions:
1.coronary artery disease with essentially single vessel involvement of the mid and distal anterior descending.
2,evidence of wall motion abnormality in the distribution of the left anterior descending.
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367994_tn?1304957193
1.coronary artery disease with essentially single vessel involvement of the mid and distal anterior descending.

.....The left descending artery has developed some blockage at the mid to distal location of the artery.

2,evidence of wall motion abnormality in the distribution of the left anterior descending.

.......Wall motion abnormality indicates there may be some impairment of the heart to adequately pump oxygenated blood into circulation with each heartbeat. I assume the subject vessel is not supply enough oxygenated blood and that is causing wall motion impairment.

Thanks for the question and if you have any further questions or comments you are welcome to respond.  Take care.
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Avatar_n_tn
Thank you for your reply.
Could one or both of these be a birth defect?
Carolyn
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367994_tn?1304957193
Your vessel/vessels could have a congenital defect that inhibits good blood flow,,,,such as being twisted, abnormal narrowing, etc. But the problem with a higher probability would be occlusions due to plaque buildup within the vessels.

Hope this helps.
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976897_tn?1379171202
You state "coronary artery disease" and this is not a birth defect. The ventricle wall movement is problematic of the blood supply through the blockages.
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367994_tn?1304957193
QUOTE: You state "coronary artery disease" and this is not a birth defect.......I'll take that comment>                                                                              

I may be wrong but I think CAD caused by a tortuous vessel (malformed vessel(s) with critical twists and turns (abnormal configuration) will cause an occlusion.  This is beyond a doubt a congenital anomoly...just one example. Obviously, CAD is not birth defect..we all know that it seems.

Also, a congenital endothelium (lining of blood vessels) disorder can cause CAD.  There are other vessel defects that may be genetic in nature .... it may not stretching it a bit to say a genetic predisposition is a birth defect...a tortuous vessel is clearly a congenital defect, and that can cause CAD.  No one is born with CAD as you have stated.

QUOTE: The ventricle wall movement is problematic of the blood supply through the blockages.

.....Heart wall movement impairment can have a congenital defect as the underlying cause, and not necessarily due to ischemia (lack of blood flow).

Thanks for your comments.  
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Avatar_n_tn
Mr. keith,
Thank you for your relpy.
Those were conclusions.  If I could quote you a couple ofs statements, and I realize this is  out  of context.  
"In any event, the right coronary was a smooth walled, good size vessel which distally divides into a moderate size posterolateral branch and a small posterior descending.  the left main coronary artery is normal in appearance.  It divides into a good size circumflex and anterior descending.  The circumflex distally becomes essentially one large marginal and appears to be disease free.  The anterior descending is quite smooth wall proximally giving off a high diagonal branch.  In the  midportion it gives off a moderate size second diagonal which also appears to be disease free.  The ongoing LAD, however, beyond this is quite small in appearance.  There is some focal narrowing of about 90% just after this diagonal and  beyond this there is an impression of the ongoing LAD being somewhat small in caliber or perhaps diffusely diseased though it is a long vessel that goes well out to and slightly around the apex and has multiple branches off it."
Thank you so much for your opinions.  This happen ed15 years ago when I was 54.  The only problem I have now, is the same as I had  had since I was a teenager.  The funny feelings in my chest, My left arm.
Thank you.
Carolyn
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Avatar_n_tn
I received an email from you after I posted last statements.  There was no comment.  Was there a comment intended??
thank you,
Carolyn
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976897_tn?1379171202
I had a similar thing myself, my LAD though was blocked totally at the top and if collateral vessels didn't open at the bottom to allow a feed into the vessel from the other direction, I wouldn't be here typing this. My LAD was very narrow all the way down, about 3-5% of normal flow. Disease was lining virtually the complete vessel and various hospitals had different opinions about what to do. I had a triple bypass attempted but it only lasted 3 months, and it was only after the event that they decided there was too much disease for a bypass to be successful. I was told that my only solution would be to ...
A. Have an open end type arterectomy. They basically pull out the inner layer of the artery. However, it's very risky because it makes such a mess. Small vessels can catch a lot of debris and block.
B. Leave things as they are and wait until heart failure kicks in, then go on transplant list.

I spent two years visiting different cardiologists at different hospitals and arguing with them. Finally I met a Cardiologist with over 30 years experience in Angioplasty at Imperial College London, he inserted the very first stent in the UK. He was intrigued by my case and said he could tidy things up. He managed to get the catheter through the main blockage, a task deemed impossible by everyone else, and rotablated three quarters of the LAD. He then installed 5 of the longest stents available. Watching the angiogram, it was a real jaw dropping moment to see the LAD suddenly swell up to normal size when he broke through the blockage. I immediately lost all angina symptoms I was experiencing at rest and even my ECG improved.
With blockages, it isn't really a matter of the size of the blockage that counts. It has been realised that a 10% blockage can give far more symptoms than a 90%, which does seem odd I know.
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367994_tn?1304957193
QUOTE: I received an email from you after I posted last statements.  There was no comment.  Was there a comment intended??
thank you,

......Wow! I don't have a record of sending you an E-mail?! :) I probably messed up, and I hope I didn't cause you any inconvenience (:.

QUOTE: The ongoing LAD, however, beyond this is quite small in appearance.  There is some focal narrowing of about 90% just after this diagonal and  beyond this there is an impression of the ongoing LAD being somewhat small in caliber or perhaps diffusely diseased though it is a long vessel that goes well out to and slightly around the apex and has multiple branches off it."

.....Relatively narrow vessels are commonly affected by atherosclerosis and can become blocked, causing angina. However, what should be considered is the anatomical configuration of the 4 major arteries and their branches for distribution of oxygenated blood to the heart cells. The possible configurations can include whether the geographic mapping of the blood distribution is right dominant or left dominant as well as other variations. Also, of significance is the area that may lack good blood perfusion at that effect on heart wall movement (hypokinesis).  For example, the lack of good blood flow to the distal part of the heart will not impair heart wall contractions as would the proximal area of the heart as the distal part doesn't contract much normally. So there will not be significant loss of blood pumped with each stroke.

Also for example, I have a totally blocked left ascending artery (widow maker), but my heart's vascular system is **("right dominant") indicating there is good blood flow to the apex of the heart and around to the left side according to my medical report.

**If the posterior descending artery is supplied by the right coronary artery (RCA), then the coronary circulation can be classified as "right-dominant".  If the posterior descending artery) is supplied by the circumflex artery (CX), a branch of the left artery, then the coronary circulation can be classified as "left-dominant".

Hope this provides some insight into the many variations of blood distribution and the significance or lack thereof.  Take care
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Ed: "With blockages, it isn't really a matter of the size of the blockage that counts. It has been realised that a 10% blockage can give far more symptoms than a 90%, which does seem odd I know".

....That is not odd, but it would be expected.  When an occlusion is opened there is more blood flow through that formally occluded vessel reducing blood flow to other areas of the heart that may no longer able to overcome the gradient pressure in other areas of the vessel network.  That is a short answer but consistant with hemodynamics.
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Avatar_n_tn
Thank you both for your comments.
After the left catheterization, the next day they proceded to do an coronary angiography.
During the  angiography, I had 3 to 4 heart attacks.  They told my son the only thing they were able to do at this point was monitor me.  That I might have to have a major attack, before they could help me.  I didn't.
They had consulted heart surgeons, who said I was an extremely high risk, since this artery was so small.  And there was no place to  insert  a stent.
After I  became stable, I spent 4 days in ICU.
When I was dismissed from the hospital by my doctors' associate, he asked me if I knew how lucky I was.  It seems, he said, that they only find this type heart defect in autopsys.
He said we never find this heart defect in a live person.

He also said if I had ever smoked, or not take care of my health ( I wieighed 115 pounds at the time) I would have died 25 years before that.  Actually, I had gone to my doctor the year before, and he passed  it off as stress.  In his defense, I did not have any chest pain. And the EKG showed nothing adnormal.. Chest pain was never one of my symptoms.

This happened in '94 near Dallas, Tx. When I go to doctos' here in Northern Mississippi, they
look at me as if I'm a nut case. I did find these  reports when I was unpacking last week, that's why I inquired.  Since hosptials do not keep records after 15 years, I will be taking copies to  my area doctors.

Thank you both for your comments...
Carolyn
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367994_tn?1304957193
Thanks for the additional information.  Kinked, twisted, elonged, small size vessel(s) are birth defects that will easily become occluded.  It seems to me, if you are experiencing a problem based on a tortuous or small vessel(s) a stent would not be an option.  A bypass would be the remaining option if intervention is required.  Take care.

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Avatar_m_tn
Wow ed  I would just like to say how happy I am for you.
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