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EBT 419 and Heart Cath?

Asymptomatic 49 y/o male, 5'9 210 lbs. with strong hx of heart disease (father died during bypass/2 grandparents died in 50's from heart attacks & 2 siblings have heart disease). EBT scan 1 y/o revealed score 137 (75-90%) in Rt. artery--now scores tripled in 1 year and localized to Rt. artery--419 with 7 cac (99%). Nl. ekg and stress test (l y/o) Cholestrol 162/LDL 73/HDL 55 on 40 mg. liptor and hx of high Triglycerides 191 & 168.  Cardiologist recommends heart cath and poss. stents due to strong family hx and tripling scores--when trying to schedule heart cath. surgeron said he won't recommend cath without sx. due to risks?  Please advise?
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Avatar universal
Hi, I had bypass surgery 14 months ago single bypass, mammary to LAD. I was told the surgery was a success. I just had a stress test 2 days ago and was told there's abnormal flow to the front of my heart in the same area where the bypass was done. It was highly recommended that I have a Heart Cath done to determine what the problem is and then "hopefully fix it" when I am there.

You had an EBT scan? Mind if I ask what that is?

I'm 2 years older than you with a similar family history.

Thank you


Helpful - 0
Avatar universal
Hi Mom,

I don't really think that a lot of doctors have a good understanding of the dynamics of coronary artery disease.  They are indoctrinated into a belief system which is distorted by the huge amounts of revenue generated by angioplasty and CABG surgery.  They really try hard to believe that they are helping people but these procedures are greatly overpracticed.

A stent is forever.  It's a foreign object.  It may work, but it may set the person up for bypass surgery at some future date.  CABG itself is good for an average 7 to 10 years.

As a 49 year old man with severe coronary artery disease, after studying much of the research, I didn't like the bypass surgery option.  I came to the belief that I could reduce the risk of another event, stabilize my existing plaques, and return to vascular health with agressive mult-drug lipid therapy and moderate lifestyle changes.  Fortunately I have a good liver and could take the drugs.

One thing to remember about CAD.  It took you 20-30 years to walk into the woods and it takes time to walk back out.  Plaques can be stabilized and the lipid pools can be drawn out of your arterial walls.  Your endothelial system can return to health.  It does take a new course of action and time.

All of that said, I'm personally on the wrong road again.  After 7 years of health I have got complacent.  I've gained a lot of weight and drink most nights of the week.  So far I have gotten away with it, but I know there is a crash ahead.

I have started to change course and really have to get back to how energized I was for change after my heart attack, if I want to live.  I'm starting to see that it's a matter of life or death and I really would like to live.  I'm blowing my second chance.  So maybe I can get on the right road again before too much damage is done.





Helpful - 0
Avatar universal
Hi Mom,

I don't really think that a lot of doctors have a good understanding of the dynamics of coronary artery disease.  They are indoctrinated into a belief system which is distorted by the huge amounts of revenue generated by angioplasty and CABG surgery.  They really try hard to believe that they are helping people but these procedures are greatly overpracticed.

A stent is forever.  It's a foreign object.  It may work, but it may set the person up for bypass surgery at some future date.  CABG itself is good for an average 7 to 10 years.

As a 49 year old man with severe coronary artery disease, after studying much of the research, I didn't like the bypass surgery option.  I came to the belief that I could reduce the risk of another event, stabilize my existing plaques, and return to vascular health with agressive mult-drug lipid therapy and moderate lifestyle changes.  Fortunately I have a good liver and could take the drugs.

One thing to remember about CAD.  It took you 20-30 years to walk into the woods and it takes time to walk back out.  Plaques can be stabilized and the lipid pools can be drawn out of your arterial walls.  Your endothelial system can return to health.  It does take a new course of action and time.

All of that said, I'm personally on the wrong road again.  After 7 years of health I have got complacent.  I've gained a lot of weight and drink most nights of the week.  So far I have gotten away with it, but I know there is a crash ahead.

I have started to change course and really have to get back to how energized I was for change after my heart attack, if I want to live.  I'm starting to see that it's a matter of life or death and I really would like to live.  I'm blowing my second chance.  So maybe I can get on the right road again before too much damage is done.





Helpful - 0
Avatar universal
It certainly sounds like you have risk factors, especially with ancestry and weight.

The bottom line is that you want to mitigate those risk factors and a heart cath is probably irrelevant in accomplishing that.  Also they might end up stenting you, which would be counterproductive to the long term restoration of your vascular health.

There are always the scare stories about people dropping dead from a heart attack.  A big reason that they are so prevalent was that they were widely used, and still are, as sales pitches for catheterizations, angioplasty, and bypass surgery.  It's very easy to scare people, who don't know anything about the subject and revere doctors opinions, into expensive and unnecessary procedures.  It sounds like you have a good doctor who uses common sense.

I've always been a student of logic and cause and effect.  As the CC doc stated, existing stable plaques are at very low risk for causing cardiac events.  It's typically the lipid rich infections in your arteries, which may not be detected with a traditional angiogram, which are at high risk of breaking out or leaking and causing problems.

I had a cath after my M.I. seven years ago.  It detected a 100% block of the RCA and a 70-90% block of the circumflex, but no significant problems in the left main.  A year and a half latter a second angioplasty attempt was aborted because a "cratered" plaque was discovered in my left main.  

I was told that, if I didn't have immediate bypass surgery, there was a 40% chance that I would experince sudden death within 5 years.  I asked why, if that plaque didn't kill me when it broke the first time, that he felt it was a danger now?  His answer was that it could reform it's cap and do it again.  That logic seemed a bit weak to me.  I think that this cap came off because 2 years of agressive lipid therapy had left it dry and the hydraulic stress had simply tore of the cap of the empty lipid pool.

Anyway you have already done the biggest part of reducing risk - correcting your lipid balance - you seem to have a perfect lipid profile on the Lipitor.

Other things that you can do are:

* Lose weight
* Eat Green Stuff
* Walk a couple of miles every day
* Relax
* Eliminate Stress
* Take vacations and time off
* Get financially healthy

Stay on the Lipitor, reduce risk and promote a healthy vascular system with moderate lifestyle modification, and you will life long, healthy and happy.  Don't worry about your ancestors.  No need to stick a catheter in you.

Helpful - 0
Avatar universal
Hi there,

I just wanted to say I loved your post.  Good advice too.  I like how you questioned your doctor about the ruptured plaque.  Good point.  Take care (:
Helpful - 0
239757 tn?1213809582
MEDICAL PROFESSIONAL
Anacyde and others,

Anacyde, that really is a horrible story and Im dearly sorry for your loss. I want to clarify though that a heart catheterization does not in itself identify what is generally the plaque in the artery that evetually leads to a heart attack. In fact, it is generally the plaques in the artery that do not have significant stenosis in an angiogram that are more prone to rupture.  This is a fact that is difficult and often hard thing for both patients and cardiologist to cope with.  

The absolute most important thing we can do is to try to prevent any  
plaque that has accumulated in the artery from rupuring or become unstable. This is done with intensive risk factor modification.

Stories like yours do scare people into having a lot of expensive test from stress test, EBCT, MRI or even catherization. Sometimes these test can lead to a false sense of security, when the best medicine is to lead a healthy lifestyle and take appropriate medications.

good luck!
Helpful - 0
Avatar universal
It should also be pointed out that tests today are MUCH better then they were 22 years ago. Spending most of my childhood in and out of hospitals I can safely say medicine has come a long way since I was young and I am only 21.

But with a strong family history I would go ahead with a cath just to be on the safe side. Remember all invasive tests have risks and you need to weigh the risks with the benefits.

Of course discuss this with your doctor.
Helpful - 0
239757 tn?1213809582
MEDICAL PROFESSIONAL
mpfjjf,

thanks for the post.

Its a difficult situation and you will get a number of opinions on what to do with abnormal screening test that detect coronary artery disease. There isnt a good body of evidence that suggest that without symptoms or other high risk features, that either percutaneous or surgical revascularization can prolong life.

Since Im not privy to all of your data, its hard to say what the right next step is. Personally, I do not use EBCT to screen asymptomatic patients. Depending on the data though, if you were a patient that came to me with those results, my next step would either be a stress test looking for high risk features or cath.

good luck
Helpful - 0

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