LAD Blockage

[Guardguy]

I have had atrail fib issues since 1985.  My cardiologist has me complete stress tests at least once a year.  Last year, my stress test showed "something".  A subsequent heart cath revealed that I had a 40-50 blockage in my LAD.  No stint was inserted during the cath and I had no problem with my continued exercise program of 1 to 1.25 hours four to five days a week.  My annual stress test two weeks ago has been interpreted as "mildly abnormal".  My cardiologist told me today that he was not overaly concerned with the results but that the imaging did show that a small portion of the front side of my heart was not being oxygenated sufficiently and that this was most likely attributed to the LAD blockage.  I had no problems during the test and stayed on for over 11 minutes, reached level 4, and my peak heart rate was 169.  I am 57 years old.  My cardiologist indicated a cath was justified "if I wanted it".  However, he was leaning towards not doing anything right now but to try to get my LDL down and do another test in 6 months. I do not feel qualified or equipped to know whether or not I should ask for the cath.  My cardiologist stated that my blockage was now probably 60% or more.  I did not have any other blockages last year.  How do I know if I should "wait and see" or go ahead and have the cath to make sure nothing is wrong sufficiently to endanger my life?

[kenkeith]

AHA/ACC guidelines:With blockage 70% or more intervention (stent, bypass) may be the option if medication cannot control angina (chest pain due to aschemia)...I have been aware of a 100% blockage of the LAD (collateral vessels developed a natural bypass, and I have 72% blockage of the circumflex.  With medication, includes lipid med) the condition is stable, and I take a nitrate (to prevent angina) before exercising at the Health Center.  

Almost everyone has some occlusion after the age of 40 and a stress test would show something less than "normal" or optimum perfusion to heart cells...that shouldn't be the criterion for a cath.  If you are concerned because of family history, etc., a CT scan angiogram, 64 slice would provide better evaluation as the scan includes images of the vessel anatomy that includes the soft plaque (between inner lining and outer lining) as well as the hard plaque formed on the inner lining.  It is the soft plaque that poses a risk for heart attack as it may rupture through the inner lining causing a clot...clot can beak away and cause an MI or stroke.  Hard plaque causes blockage and reduces blood flow to heart cells...usually causes chest pain and over time can cause hypokinesis (impaired heart wall movement).

I don't know the exercise protocol regarding your test, but the Bruce protocol for 11 minutes without exceeding your heart rate is very good.  That would represent more than 12 METs and very good heart fitness.

There is a risk with a cath and the risk exceeds any benefit.