Heart Disease

[MrBert]

I am a 64 year old male. I had an angiogram yesterday wherein the surgeon inserted  stents on my CX (60% occlusion) and LAD(95% ocllusion). MY RCA is at 80%-90% occlusion but no stent was inserted. I've tried to analyze why the RCA wasn't touched but no logical answer I can come up with. Before I was released today, the cardioloigist ( my doctor but who didn't do the procedure because he has a bad back; his partner did the procedure) started off  by stating that the procedure was more complicated than they thought. When asked about why the RCA was not stented, he stated it was too diffucult to get to( which doesn't satisfy my question) and that we would try medication and watch it. Does anyone know the real reason or are those 25lb. lead jackets the doctors  wear just too heavy for a longer procedure? Can an RCA ever be stented? My LM occlusion is at 20% and the midCX is at 50%. Should I worry soon or later about either going through another angioram or open heart (which I'd like to avoid).  All my vitals, cholesterol, BP, pulse, echo test, etc are all excellent and not even close to danger points. Am I a ticking time bomb?  I've been put on Effient. Thank you for your responses.  

[Flycaster305]

The doctor who did the procedure will have  written a report and it is on file at the hospital where the cath was performed.  This report is available to you, and I suggest you obtain a copy.
Another option why the 85% blockage didn't receive a stent might be that the vessel was very twisted or small or both.  

[nagrajjain]

If your EF in 2decho is greater than 40% and you do not have any symtoms after attack you may be in a position to carry on with medicine. I had two heart attacks and my angiograph shows blockeges more than yours. I am carrying on with medicines after second attack for more than six months. I do not have any symtoms and no pain too. You may refer to my postings.

[kenkeith]

You're welcome.

Ken

[MrBert]

Ken: In retrospect, I experienced (based on my description to all the doctors) an angina attack while I was trying to catch a flight from Honolulu to the mainland about 3 weeks ago.. I was under a lot of stress, running/walking about a 1/4 mile with about 50 lbs. of carry ons( my wife's) and with my plantar fasciitis boot on my left foot. I suffered the chest pains immediately after I settled down in my seat. It  was a type of pain I never experienced before or after; it lasted about 3 minutes. The correlation I can draw from that experience is that when the ultrasound showed there was blockage on at least one artery, the doctor asked if I had chest pains on my way to the clinic that morning; question was asked as I was on a rest position on my left side. Thanks again for your response; nice to hear from someone who has experience in this area. Take care!

[kenkeith]

MrBert, there should always be a concern for any abnormal condition.  Trying medication and watching does not sound unreasonable.  I have a totally occluded left ventricle (collateral bypass) and a 70% occluded vessel and have been treated and watched for about 7 years. I take medication, and don't have any symptoms.  I feel well, and no side effects from medication, and it appears there has been no progression.

If you don't have any symptoms such as chest pain (angina), it would indicate your heart cells are receiving sufficient oxygenated blood.  Usually, occlusions less than 70% should not be stented according to the AAC/AHA guidelines, but apparently that was done?  Did you have chest pains? Do you now have chest pains?  That should be a consideration before any intervention and whether or not medication can be beneficial.

Hope this helps,

Ken

[MrBert]

Thank you for your response. However, are my concerns valid or not?  

[kenkeith]

You RCA is occluded to the extent there may be a deficit of good blood supply to the location normally supplied by the RCA.  There could be a couple of reasons the doctor does not prefer to stent.  The RCA may have developed collateral vessels that have formed a natural bypass.  Also the blockage maybe at the distal end and not very significant in terms of needing a good supply of blood.  

Another consideration may be that your vessel system's configuration is left-side dominate as opposed to right dominate.  Usually, if I remember correctly the right-side dominate the RCA wraps around and under the heart to some blood circulation to the left side.  Left-side dominate more extensive blood flow to the area and RCA isn't involved.  And there may be a different configuation or a combination of the two.