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LAD blockage and no Angina
Without having any chest pain at any time, even after having a jogging of 1-1/2 Km, but since having blood pressure and cholesterol since long, my doctor has advised my to have CT coronary Angiography. The test was positive and found 80 % blockage in LAD (middle). Even to day, say after one year of the said test I am not feeling any chest pain or any body pain (shoulder or head or hand etc..) My doctor suggest me a angioplasty, for prevetion. I specifically want to know, is this correct ? Is this possible that person has no uncomfort chest having such blockage ?
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hello
my name is sahil pabby and i am 21 years old.
i ve been dignosed with lvef 18% when i was 18 years old and now it has become 30%.
i take regular medication of -
cardivas 12.5 - 2 times a day
cardace 10 - 2 times a day
lanoxin
dytor plus 10
and ecosprin.
what are the chances and how can i improve it..??
my name is sahil pabby and i am 21 years old.
i ve been dignosed with lvef 18% when i was 18 years old and now it has become 30%.
i take regular medication of -
cardivas 12.5 - 2 times a day
cardace 10 - 2 times a day
lanoxin
dytor plus 10
and ecosprin.
what are the chances and how can i improve it..??
hello
my name is sahil pabby and i am 21 years old.
i ve been dignosed with lvef 18% when i was 18 years old and now it has become 30%.
i take regular medication of -
cardivas 12.5 - 2 times a day
cardace 10 - 2 times a day
lanoxin
dytor plus 10
and ecosprin.
what are the chances and how can i improve it..??
my name is sahil pabby and i am 21 years old.
i ve been dignosed with lvef 18% when i was 18 years old and now it has become 30%.
i take regular medication of -
cardivas 12.5 - 2 times a day
cardace 10 - 2 times a day
lanoxin
dytor plus 10
and ecosprin.
what are the chances and how can i improve it..??
"Unfortuately a stent doesn't reduce the risk and in some situations it increases the risk of a serious event within a year or later. That is not including some minor risk of the intervention itself."
I agree within a year, but after four or five years, the success rate is around 98-99% with only 1-2% re-occluding. It seems once through the first year, the stent is very reliable but most research seems to only go on for about 5 years with a wide sample.
In the 70's, when ballooning was used, around 40% of vessels re-occluded. With the first bare metal stents, this dropped to 20%. With drug eluting stents it dropped even lower. After one year, the two stent types are pretty evenly matched.
With a 1-2% chance of re-occlusion after 4-5 years, would you class this as risk reduction compared to still having the plaque there?
I agree also that there are minimal risks involved in stent placement, but that's something which can be reduced by ensuring you have an experienced Cardio.
"The altered integrity of the vessels downstream may be vulnerable to reperfusion injury"
Do you have a resource for this please? It will be very interesting. I've heard of CO2 lasers causing damage.
I agree within a year, but after four or five years, the success rate is around 98-99% with only 1-2% re-occluding. It seems once through the first year, the stent is very reliable but most research seems to only go on for about 5 years with a wide sample.
In the 70's, when ballooning was used, around 40% of vessels re-occluded. With the first bare metal stents, this dropped to 20%. With drug eluting stents it dropped even lower. After one year, the two stent types are pretty evenly matched.
With a 1-2% chance of re-occlusion after 4-5 years, would you class this as risk reduction compared to still having the plaque there?
I agree also that there are minimal risks involved in stent placement, but that's something which can be reduced by ensuring you have an experienced Cardio.
"The altered integrity of the vessels downstream may be vulnerable to reperfusion injury"
Do you have a resource for this please? It will be very interesting. I've heard of CO2 lasers causing damage.
Unfortuately a stent doesn't reduce the risk and in some situations it increases the risk of a serious event within a year or later. That is not including some minor risk of the intervention itself.
There can be persistent coronary occlusion due to a combination of organizing thrombus, occlusive plaque disruption, or localized dissection. These features present technical challenges for PCI operators and have been associated with PCI failure and periprocedural complications. The altered integrity of the vessels downstream may be vulnerable to reperfusion injury. Reperfusion injury is DAMAGE to heart cells with recanalization (restablished blood flow). That can't be ruled out, and almost never if ever included with an evaluation with a cardiologist, but certainly should be of interest to a good surgeon
There can be persistent coronary occlusion due to a combination of organizing thrombus, occlusive plaque disruption, or localized dissection. These features present technical challenges for PCI operators and have been associated with PCI failure and periprocedural complications. The altered integrity of the vessels downstream may be vulnerable to reperfusion injury. Reperfusion injury is DAMAGE to heart cells with recanalization (restablished blood flow). That can't be ruled out, and almost never if ever included with an evaluation with a cardiologist, but certainly should be of interest to a good surgeon
The ' prevention' which your cardiologist is referring to, is the prevention of serious heart attack and possible death. According to statistics, any blockage over 70% is at high risk for rupturing. The pressure of blood against the plaque can weaken it, enabling the softer plaque to break free causing a total blockage. The LAD is not a good vessel for a total blockage. You have 2 basic options, 1. Hope medication prevents the rupture and rely on the luck of the Gods, or 2. have the blockage treated. Luck works with some people, but not all. I don't know if you know how serious the plaque is at 80%? this is how people feel great one minute and then have a serious heart attack the next. If you have the chance to have it stented, why would anyone want to live with the high risk, that's what I don't understand. It has nothing whatsoever to do with how you feel. Great if there are no symptoms, but there is still an 80% blockage acting as a time bomb.
Chest pain has many causes. It can relate to the respiratory system, there can be the chest cage that is causing the problem...the ct scan probably ruled out any coronary occluded vessels causing the problem, but there can be artery spasms that are causing chest pain.
Thanks for sharing, and if you have any followup questions you are welcome to respond. Take care. Regards.
Thanks for sharing, and if you have any followup questions you are welcome to respond. Take care. Regards.
im 32 yrs old man from malaysia.having chest pain and almost 1 year.my ct angiogram was negative but still having chest pain.
Vikkie, it is somewhat ambiguous for a cardiologist to say "suggest angioplasty to prevent...." not very clear what is to be prevented. Angioplasty and bypass heart surgery treat coronary artery disease almost always for relief from unstable angina (angina with exertion, but no angina at rest). Most coronary artery heart attacks occur as a result of soft plaque (plaque outside the lumen between layers of the vessel) rupturing causing a clot within the lumen and then a heart attack from that blockage. Your CT angiogram should have given some information regarding the vessel anatomy and calcium scoring regarding soft plaque.
For some insight, plaque buildup in lumen may impede sufficient flow of oxygenated blood to the heart cells causing pain (angina) and a warning that if untreated the insufficient blood flow will damage the heart cells and heart wall movement (contractility) will be impaired leading to heart failure if not successfully treated. If medication can open vessels sufficiently to provide adequate oxygenated blood flow to otherwise deficit areas of the heart, then intervention may be unnecessary. I doubt just one vessel that is 80% blocked is critical especially in view of the other relatively good health information and no symptoms.
A stress test can measure blood flow at rest and then blood flow with a gradual increase of exertion to determine degree of induced ischemia and watching by monitor as exertion is increased. The result will determine the degree of impairment with medication and/or without.
For some insight, plaque buildup in lumen may impede sufficient flow of oxygenated blood to the heart cells causing pain (angina) and a warning that if untreated the insufficient blood flow will damage the heart cells and heart wall movement (contractility) will be impaired leading to heart failure if not successfully treated. If medication can open vessels sufficiently to provide adequate oxygenated blood flow to otherwise deficit areas of the heart, then intervention may be unnecessary. I doubt just one vessel that is 80% blocked is critical especially in view of the other relatively good health information and no symptoms.
A stress test can measure blood flow at rest and then blood flow with a gradual increase of exertion to determine degree of induced ischemia and watching by monitor as exertion is increased. The result will determine the degree of impairment with medication and/or without.
Thanks Ken. I would like to add.... (i) I am 44, (ii) No smoking, (iii) Alcohol around once a month (iii) Not diabetic at all (iv) Regulalrly Excersing (v) Slightly overwieght as I am 5' 5" having 71 Kgs.
Should I go for detailed investigation and some sets of opinion ? or should I wait for sympoms ?
I am obliged for your valued opinion.
Should I go for detailed investigation and some sets of opinion ? or should I wait for sympoms ?
I am obliged for your valued opinion.
Yes, it is possible to have vessel (coronary) occlusions and not experience any symptoms until there is heart failure...especially true for older indivduals and diabetics.
If you were experiencing angina (chest pain, etc.), shortness of breath, fatigue and medication provides relief, then one could almost always forgo interventional procedures, but if you don't have symptoms, there is no reliable way to know if medication is effective for your CAD.
If you don't have symptoms, why are you having heart related tests? An 80% LAD may not be a problem...there may be other vessels that feed blood to the area deficit from an 80% occlusion. It seems a big jump to angioplasty based on the information you provide, and you may want to get another opinion.
If you were experiencing angina (chest pain, etc.), shortness of breath, fatigue and medication provides relief, then one could almost always forgo interventional procedures, but if you don't have symptoms, there is no reliable way to know if medication is effective for your CAD.
If you don't have symptoms, why are you having heart related tests? An 80% LAD may not be a problem...there may be other vessels that feed blood to the area deficit from an 80% occlusion. It seems a big jump to angioplasty based on the information you provide, and you may want to get another opinion.
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