Ongoing chest issues & cath interpretation.

[phorsenuf]

In 2008 I had a heart attack.  I was 44 at the time.  Lately I've been having issues.  I saw the cardiologist today and didn't really get any where except more meds.  Now granted this is a new Dr so he's not familiar with my case.  
But lately my blood pressure has been all over the place, Not too too bad, but higher then normal.  158/92 or 148/100 or 136/82, etc.  I've also been having chest discomfort, shortness of breath, pain in the back, tingling in my left arm and up the side of my face.  Some light-headiness and vision issues.
Anyway, I pulled out the copy of my cath (I need to send a copy to my nee Dr.) and I was reading it over and hoping someone can decipher a few things for me.  My previous Dr never gave me any straight answers as to what was going on.  Very frustrating!

These are some things noted in the report.
Calculated left ventricular ejection fraction 69%, small region of focal hypokinsis in the apex.
Mild irregularities noted at the ostium of the left anterior descending artery (10-20%)  
Left circumflex is a large-caliber vessel and appears to be codominant.  Vessel free of significant focal disease .  Two mid marginal branches are noted, first marginal branch has a bifurcation branch that appears to be subtotally occuluded.  There appears to be diffuse disease in this very small caliber vessel.  The remainder of the marginal branches in the left posterior descending artery are free of significant disease.  The ostium of the circumflex is noted to have mild irregularities (10-15%)
The right coronary artery is noted to have mild irregularities in it's proximal segment (10-15%).  No significant disease noted in the right coronary.  
Branch vessel disease involving a very small marginal branch.

What does this all mean?  And based on what is said almost 3 years ago could things have worsened since?

Thanks so much!

[Flycaster305]

I'm not a health professional, but it seems you have some classic warning issues of some type of heart issue.  As both Ed34 and I can attest, changes in blood vessel occlusion can occur very, very quickly.  I'd think your new doctor will suggest a stress test, and if not, I'd urge you to suggest and encourage it.  A three year old stress test result is, in my opinion, worthless as a diagnostic tool.
Keep us informed.

[kenkeith]

Irregularity is not usually a reference for occluded vessels.  And the percentages provided do no conform to the usual specification that are noted of blockage greater than 50%.  A cath angiogram has a sensitivity and reliablility rating for occlusions less than 50% is very poor. It seems the posted 10-20% irregulariities relate to surface geometry  of the vessel that represents the vessel concentricity, sphericity, and radius of sphere are found that can cause flatness of the vessel or its cylindricity, etc. and the percentage given relates to blood flow reduction not stenosis. Just a thought!

Thanks for your question.

Ken  

[ed34]

It basically says mild coronary artery disease but your heart is working fine. There is a small area of the apex which isn't moving as quickly as the rest which could be lack a restriction in blood flow. If you had an angiogram a year after that, it can look very different indeed, depending how quickly the disease progresses, if at all. It obviously depends on many things such as diet, exercise, genetics, stress levels, cholesterol levels, blood pressure etc etc.
The angiogram results you have there, three years old, are basically useless now unless they need to look at the history.