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How is the degree of coronary blockage established?
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How is the degree of coronary blockage established?

I have 3 stents and have had numerous heart caths along with a heart attack. I'm having significant issues again with a recent nuclear stress test pointing out numerous issues from suspected blockages, irregular heart beat, and a host of heart muscle related issues.
My stents were in the LAD, RCA, Circumflex.
I have been to 3 cardiologist since moving here from another state. First one stated I have 60% reocclussion in all 3 vessels. Second cardiologist told me 50% while the current told me 40-50%. How can there be so much variation??
When having a heart cath, do cardiologist have a scienticfic method of evaluating and determining degree of blockage or is it just an educated guess from experience???
None of the cardiologist will touch a blockage under 70%.........don't know why but I don't especially like playing Russian Roulette with a 95% occluded LAD like I had the first time.........and without any indication!! It was found totally by luck as I was having surgery and going for physical therapy. My physical therapist noticed I huffed and puffed too much while on some of the machines and suggested I see a cardiologist! She was a God's Saint that I'm still here today since we have a serious problem with MCI in our family both maternal and paternal. There was never a lack of exercise in my case so I am assuming it was genetics and diet???
1 Comment
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Avatar_dr_m_tn
The way that cardiologists determine the degree of blockage in a coronary artery involves several different mechanisms.  A variation of 10-20% for a lesion is not uncommon (the 40-60% variability that you mentioned).  There is no clinically meaningful difference between a 40% and a 60% lesion (it means you have a moderate blockage in that coronary artery).  70% narrowing is typically the cutoff for when it is indicated to place a stent, but that is an "older" indication based on what the cardiologist has estimated on visualization of the catheterization images (there are software programs used in almost every cath lab that will determine the luminal narrowing exactly, but these are based on the 2dimensional images that catheterization provides and are not 100% accurate).  A better way to determine if a coronary artery, moderate lesion is clinically meaningful is to perform intravascular ultrasound (IVUS) or fractional flow reserve (FFR) during the catheterization.  These methods are much more accurate in determining the severity of luminal narrowing/blockage and whether blood flow is impaired because of that blockage in the heart.
Coronary artery disease is a complicated disease that involves many, many risk factors; the most common of which are smoking history, family history/genetics, diet, environmental factors, and gut flora (to name just a few).  
Hope that helps.
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