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How to treat Diffuse Triple Vessel Disease ?
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How to treat Diffuse Triple Vessel Disease ?

My Father has Diffuse Triple Vessel Disease.
He is 72 and non-diabetic.
He doesn't have any symptoms and he is very normal.
He had a mild chest pain when walking so the doctor adviced to take angiograph after TMT.

Angiograph Report :

Left Main - Normal

Left Anterior descending Artery -
type 3.Proximal LAD is calcified.Mid LAD has two tandem lesion of 80% & 90% respectively.Distal LAD has 80 to 90  % long segment lesion.

Diagonals -  
D1 is a large sizedvessel.
It has multiple 80-90% lesions.

Left Circumflex Artery -
Non-dominant - Proximal LCX is calcified .
Mid LCX has 90% stenosis.Distal LCX has 90% Stenosis.

Obtuse Marginal Branches -
OM1 is a large sized vessel.
Its lower division has 80% stenosis.
OM2 is a large sized vessel .It has 80%ostiproximal lesion,.
OM3 and OM4 are moderate sized normal vessels.

Right Coronary Artery -
Dominant  - Proximal segment has 90% stenosis.Mid segment is totally cut off.
Remaining  RCA,PDA & PLV are visualized thro, ipsilateral collaterals from proximal RCA.

FINAL IMPRESSION -  Diffuse Triple Vessel Disease

Advise -Early CABG.

This was the Report.

Medicine Prescribed by the doctor :

Atrovastatin Tablets IP 20 mg - CAAT 20
Nitrolong 2.6 -Nitroglycerin controlled Release Tablets 2.6 mg
Happi-it     -      Rabeprazole 290mg EC & Itopride 150mg SR Capsules
Clopilet A 75   -   Clopidogrel and Aspirin Capsules
Esamilo - 2.5     -      S(-) Amldipine Tablets IP
Ativan 1mg     -  Lorazepam Tablets B.P

After taking th medicines,the pain has been subsided and is very normal now.

I seek for a suggestion from you for his condition.

Thank you,
14 Comments Post a Comment
Your Father certainly does have a lot of coronary artery disease, many vessels are affected. I would have to ask how they intend to feed the heart muscle using bypasses when most areas are seriously blocked off. The distal LAD is one common area for a feed, but this is heavily diseased. The report does say how the complete blockage in the MID right coronary artery has bridged with collaterals (natural bypass vessels). I would also have to guess this is happening to many other blockages or he would be very seriously ill due to the left side of the heart being so short of oxygen.
Have they mentioned anything about a Nuclear scan to establish which area/s are causing the problem, giving a better guide where to attach the bypass vessels? It could be that one vessel is giving a lot of collateral feeds but due to disease this has reduced, meaning only that one vessel would need bypass. A nuclear scan shows which areas of the heart muscle are not receiving the right amount of oxygen. An angiogram doesn't give this information because most collateral feeds are far too small to be seen.
Lad-Type 3 vesel,proximal LAD shows plaquing,mid and distal LAD diffusely diseased.
Lcx-Non dominant,proximal LCX shows non critical plaquing,continues as Major OM
Marginals-Major OM -proximal non critical plaquing,mid-distal 90% bifurcation lesion
Rca-Dominant,Proximal RCA shows non critical Plaquing,Mid&Distal RCA diffusely diseased.
LV-no RWMA,Normal LV systolic function,LVEF-60%
Final Digonosis-CAD-Normal LV systolic Function

Dear Sir
Please guide me what is the solution doctor told its severly damged nothing can be done they are discussing with surgon.I am showing in Naryana Hrudayalaya.Please guide me what is the solution and next step .IIs CABG is the solution.my email is ***@**** we are in hospital please guide me.
I am not a Doctor, but looking at your report I am a bit confused. It is missing a fair amount of detail, such as the amount of plaque in the LAD vessel. It simply says "Plaquing". The main issue appears to be the Obtuse Marginal vessel OM which is 90% blocked at a junction with another vessel. I have no idea why they cannot stent this? Your heart is certainly not DAMAGED? your LVEF is 60% which is absolutely fine and your heart muscle is moving just fine. In fact the report states LV No-RWMA which is Left Ventricle, there are NO Regional Wall Motion Abnormalities. It then says NORMAL left ventricle systolic function. So your heart is working fine, so what is the emergency and where is the severe damage?
I would be a bit concerned about the 90% blockage, because this can be causing some symptoms of Angina on exertion. Other than that, I would ask about medication and lifestyle changes. I have the impression that you have probably formed some collateral feeds on your heart, which are natural bypasses. I know if this was my body and I had to make a choice, I would say stent the 90% blockage and I'm out of here. I would want good medication such as statins and beta blockers, and I would make a lot of lifestyle changes including a really healthy diet. I would then see how things progress from there. If you start to get symptoms again, then it's time for another angiogram, but technology in angioplasty is improving all the time. Remember though, I am not a Doctor, and I cannot tell you what decision to make. I can only say what I would do.
Left main : ostial left main has 70% stenosis

Ramus : ostial segment has 70% stenosis

lcx :- dominant, proximal lcx has 30% plaque
       mid lcx has 80% stenosis
       om1 has 70% stenosis

Rca : Non Dominanat,normal

renals : left renal has 30 % plaque
            right renal normal

i have the this report @ angiography
can u plz suggest me
what symptoms do you have?
Chest pain on 12th feb ... as per ecg there no attack ... and the report shows as per above ....
need an opinion
The only real concern at the moment is the middle of the left circumflex at 80% which is probably giving angina (chest pains). Perhaps a stent to this region if possible? which will give a greater possibility to develop collaterals across to the other major vessels. It might be worth OM1 being stented also because this is really a part of the left circumflex.
Lifestyle changes are of course necessary now, to prevent the other blockages getting worse.
This is just my personal opinion as you have triple heart disease.
My 75 year old father asked to undergo bypass.
His angiography report says

totally occluded from ostial segment

Non-domin angiography.  90% STENOSIS in proximal segment.  Multiple minor plaque along the course of LCX.

OMI 95% stenosis in proximal segment.  One branch of OM is occluded.

RcA: Dominant.  Multiple minor plaque along the course of RCA. 80% stenosis in distal segment
Well there is a lot of disease here. Let's look at each vessel in turn. First the left anterior descending (LAD). From what I can tell, this vessel is clear, apart from one of its branches (Diagonal) which is completely blocked. If completely blocked then there is no point in intervention. Either some muscle has died, or the Heart has opened natural bypass vessels to cope with this. A nuclear scan is required to establish the answers. Now the left Circumflex (LcX). This is non-dominant so quite a short vessel, but it is restricted by a 90% blockage at the top. This needs to be stented or bypassed. As we travel down this vessel we reach the Obtuse Marginal 1 and it is blocked by 95%. A marginal branch off the Obtuse marginal is also blocked totally. I should think that this vessel would be giving some angina symptoms. Now the Right Coronary Artery (RCA) which is 80% blocked near the bottom. This is a dominant vessel and so is very long, probably supplying the PDA at the rear of the heart. I think that the best thing to do is to have a nuclear scan and establish the areas which are not receiving enough blood. The RCA could also be supplied by collateral vessels and bypass/stents may not be necessary on this vessel. I would think that out of all the vessels, the LcX would require intervention.
Thank you. Doc says his heart muscles are strong. But I am afraid of his lungs which are relatively weak.
then I am at a loss why you would post the angio report
After two angiography in 2006 and 2007 I have more problems and the last diagnoses is Angio:80% stenosis of the RCA,in stent restenosis LAD, and the doctor tell me i need a Bypass.
I seek for suggestion from you for this situation

Kind Regards

My father has mid LAD complex trifurcation (1:1:1) 90% stenosis. LCX in the AV groove has tubular trifurcation 90% stenosis involving ostium of OM1. OM1 has ostial 95% stenosis.

How serious is the case. Please advice
There are three major coronary arteries and to have a tight blockage in two of them would be a concern. The left front of the heart is supplied by the LAD and the rear left by the LCx. With both tight blockages occurring I would think that on exertion, a considerable area of heart muscle is under stress. The OM1 also has a tight restriction but this is an extension of the LCx. If there are no symptoms in the patient in the form of angina, I would be very surprised.
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