Heart Blockage and Abnormal Arteries

Hi there,

Last Sunday, my 86 yo grandfather, who is in generally very good health, had a heart attack.  After an angiogram, it was discovered that there are 2 arteries at the top of his heart that are very narrow, 2 arteries at the bottom that are very wide, and 2 arteries in the back of his heart that are closed.  He also has a blockage in his lower chambers...right or left, I'm unsure of.  They have him on a glycerine patch and a pink pill, called something like Merck or Merick ?? and an aspirin a day, as well as Lipitor. (His cholesterol is 220)

My questions are:
1.  What is his prognosis?
2.  What is the recommended treatment?
3.  Because of the narrow/wide and blocked veins/arteries, what are his chances of a second heart attack?
4.  What would make them narrow, wide and blocked?
5.  Should a pace maker be considered?

I would sure appreciate your help!  We are kind of cocerned, because of his age, he may not be getting the best care he needs..  His overall health is great, and he's never had any medical problems...  Thank you very much!!

All my best,

[CCF CARDIO MD JMF]

Dear Lora,
  In response to your questions.
Given your fathers age, i am assuming that they did not feel that surgery or an aggressive intervention was warranted.
My questions are:
     1. What is his prognosis? If his heart function is preserved, it is reasonable although given his age, his life expectancy in general is not long.  would estimate a 20% chance per year of a cardiac event.
     2. What is the recommended treatment? He is on standard treatment for post MI. I would recommend a beta blocker and an ace imhibitor if appropriate in view of his heart function.
     3. Because of the narrow/wide and blocked veins/arteries, what are his chances of a second heart attack? As i mentioned above there is a very high likliehood that he will suffer another heart attack in his lifetime.
     4. What would make them narrow, wide and blocked? coroanry artery is a process that narrows arteries and blocks them .  this is caused by cholesterol depostition in the artery wall.
     5. Should a pace maker be considered?  From what you have told me your grandfather does not have an indication for a pacemaker  (a symptomatic decrease in heart rate or a heart rate below 40 bpm)

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A related discussion, heart blockeage was started.