Aa
Heart disease
My father is 87 years old active male, developed a mild heart attack. The angiogram revealed he has 75% block right from the mouth of the right artery. Both the other arteries are normal. He is now on blood thinning drugs. The doctor has advised only minimal physical activity and also suggested angioplast. Please advice me on whether is it necessary to undergo angioplast when the other two arteries are functioning normal. In case he can continue with diet restrictions and drugs, would there not be any problem. My father is a teetotaller, vegetarian with clean habits. No other ailment is present.
Wow, your father sounds in pretty good shape for an 87 year old! It is difficult to second guess a doctor's analysis as (s)he has much more data to support a decision.
AAC/AHA provide guidelines for treatment of occluded vessels. The guidelines are not to treat any lesion less than 70% (exception would be if there are symptoms such as chest pain), if there is treatment for symptoms, then medication. If medication does not effectively treat the lesion, then a stent implant. Sometimes stents are not a solution because the lesion is too long, difficult to assess, etc. then a bypass.
COURAGE study has concluded there is no difference for longivity with any of the 3 therapies (google for more information if interested). So it stands to reason that one would select the least invasive treatment. Seven years ago I had a mild heart attack and in ICU for several days with congested heart failure. I had a stent implant for a 98% blocked right coronary artery, 70% circumflex no intervention, and 100% blocked LAD. The LAD had developed collateral vessels (natural bypass) to supply blood to the area normally supplied by the LAD. I have been successfully treated with medication and today my heart has returned to normal size and effectively pumping blood into circulation. That has been my experience and I had a heart attack in my 7th decade of life, and I have not had any medical problems since.
I take a nitrate prior to aerobic exercise 3x a week as I have some chest pain with exertion, but none with medication. The fact there is no chest pain (angina) with medication indicates the heart cells are receiving sufficient blood flow. The nitrate dilates the coronary vessels for a better flow of blood. Does your father have chest pains with some exertion, but goes away with rest? Has your father tried medication to treat any chest pains? However, there are a percentage of older individuals and diabetics that don't experience any chest pain, etc. with exertion so to be absolutely certain your father is not in that group there is a perfusion stress test that visualizes blood flow with exertion and again at rest.
Because your father may be in the silent ischemia (vessel blockage) category, it may be wise to have a stent implant. If successful there would be no need for a nitrate, and there is very little risk.
Thanks for your sharing, and if you have any follow-up questions or comments you are welcome to respond. Take care.
AAC/AHA provide guidelines for treatment of occluded vessels. The guidelines are not to treat any lesion less than 70% (exception would be if there are symptoms such as chest pain), if there is treatment for symptoms, then medication. If medication does not effectively treat the lesion, then a stent implant. Sometimes stents are not a solution because the lesion is too long, difficult to assess, etc. then a bypass.
COURAGE study has concluded there is no difference for longivity with any of the 3 therapies (google for more information if interested). So it stands to reason that one would select the least invasive treatment. Seven years ago I had a mild heart attack and in ICU for several days with congested heart failure. I had a stent implant for a 98% blocked right coronary artery, 70% circumflex no intervention, and 100% blocked LAD. The LAD had developed collateral vessels (natural bypass) to supply blood to the area normally supplied by the LAD. I have been successfully treated with medication and today my heart has returned to normal size and effectively pumping blood into circulation. That has been my experience and I had a heart attack in my 7th decade of life, and I have not had any medical problems since.
I take a nitrate prior to aerobic exercise 3x a week as I have some chest pain with exertion, but none with medication. The fact there is no chest pain (angina) with medication indicates the heart cells are receiving sufficient blood flow. The nitrate dilates the coronary vessels for a better flow of blood. Does your father have chest pains with some exertion, but goes away with rest? Has your father tried medication to treat any chest pains? However, there are a percentage of older individuals and diabetics that don't experience any chest pain, etc. with exertion so to be absolutely certain your father is not in that group there is a perfusion stress test that visualizes blood flow with exertion and again at rest.
Because your father may be in the silent ischemia (vessel blockage) category, it may be wise to have a stent implant. If successful there would be no need for a nitrate, and there is very little risk.
Thanks for your sharing, and if you have any follow-up questions or comments you are welcome to respond. Take care.
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