LAD totally occluded at origin of first septal being cross filled by collaterals
im 54 years male four days ago i have felt angina pain and in coronory angiogram LAD totally occluded at origin of first septal being cross filled by collaterals was shown andDVCAD was diagnosis and it was advised PCI toLAD.Ejection fraction is 45%.My disease can be cured by medicine or wat should u suggest?
This type of question always sparks a variety of different opinions on this forum.
My opinion is that if the problem is giving you symtoms (symptoms), then you could go on medication, but why, if there's a was to open the vessel. Medication simply keeps your heart relaxed, stopping it from performing the full extent it should be capable of doing, so medication cures nothing. If the vessel is opened with a stent, then full blood flow will return, and so what if the collaterals do close, you shouldn't need them anymore and they are not giving sufficient flow anyway.
Due to there being a flow of blood in the area, no tissue damage will occur from revascularisation. The risks with stenting are very low and recovery is very quick and there is no discomfort with the procedure. You only have to take plavix for a year with aspirin to ensure you don't form clots, but these medicines will have no effect on your heart function.
If you imagine your heart as a high performance engine with a lot of coke build up, making it run bad, you can run it for a few years making sure you don't expect much work load from it. However, give it to a mechanic and get the coke removed, you have a fully working high performance engine again. I've had 6 stents now, and have never suffered from restenosis in them, this is because it's very rare now. You will also be on beta blockers to keep your heart relaxed and this medication, to put it mildly, is horrible. It makes you lethargic, sleepy and it becomes a real effort to find the mind power to do anything. If you obtain good vascularisation, and your heart recovers, there's a high chance you could come off these.
I'll get off my soap box now lol
There are individuals that have had numerous stents, and there is evidence that stenting one or more occluded vessel can cause problems down stream from stent implants. I certainly don't want to second guess someone's doctor who made all of the implants nor suggest the recipient should not have had the implants. But an investigation has developed evidence there are many unnecessary stent implants.
QUOTE:."Medication simply keeps your heart relaxed, stopping it from performing the full extent it should be capable of doing, so medication cures nothing..."
That is not true. Medication for vascular disease does not relax the heart. Medication relaxes coronary and system vessels and reduces the burden of high resistance of constricted vessels. Continuation of medication would be an ACE inhibitor and beta blocker medication even if a vessel(s) is/are stented. A stent does not cure cardiovascular disease, it merely treats the chest pain (angina pectoris). Other medication such as a statin for cholesterol as well may be included in the regimen.
A nitrate would be the only med not needed IF the stent implant is successful. I had a stent in the RCA and the medication did not change, nor should it!
I have had a totally occluded vessel LAD with collaterals for more than 7 years and I do perfectly well with medications. I take a nitrate prior to working out, and I have no symptoms. The nitrate relaxes the coronary vessels and the blood flows adequately...if medication is effective why an implant? One can always go to a stent if the need arises, but once having a stent there are fewer options available. It doesn't extend life
and is not a cure.
The evidence for damage of other vessels after opening an occluded vessel is termed reperfusion. "Microvascular incompetence after ischemia and reperfusion may compromise the normal postischemic coronary perfusion and additionally jeopardize the recovery of the myocytes....Coronary vasoconstriction during postischemic reperfusion is regularly present in the routine operative setting in cardiac surgery, despite myocardial protection measures. The amount of vasoconstriction varies considerably and is particularly increased in patients with hypertension. The nitric oxide donor nitroglycerin can normalize the elevated resistances, but only in high dosages. This demonstrates a preserved ability of vascular smooth muscle to relax. The phenomenon had no sequelae in our low-risk patients having elective operations. However, it may gain significance in the case of severe left heart hypertrophy and in patients at risk with both a postoperative low-output syndrome and reduced mean arterial pressures during reperfusion".
Opening a vessel that has collaterals, will diminish the blood flow through the collaterals as the newly opened totally blocked vessel will reduce the gradient pressure as blood will flow through the vessel with least resistence and no longer through the collaterals. What happens to the area that has been supllied by the collaterals? Where is the the evidence that the collateral fed area does not need a blood supply? :) Any area that has had a blood supply will require blood/oxygen otherwise the heart cells will die. If the heart cells die, that could very well cause an arrhythmia as electrical impulses will not conduct with damaged pathways.
You should rely on your doctor's opinion as (s)he has your health history, concomitant health issues, etc. I have provided a possible alternative that has worked for many
individuals including myself. The fourm has individuals that have had an unsuccessful experience, so individuals that are successfully treated with medication are not fairly represented on a forum for heart problems. So answers may be somwhat biased.
Hope this has given you a perspective that helps you understand the options available. It all comes down to whether or not medication sccessfully treats your chest pain, and that you can sustain a tolerence for physical activity and feel well. Take care.
I don't agree with that statement one bit. I believe you will find that there are many people who do not take their condition seriously enough to make the necessary lifestyle changes. They continue to smoke, they continue to eat rubbish foods, they still don't exercise regularly and they still face lots of daily stress. Just because they feel better from the stent, they carry on as they have for many years.
Let's break down your comment into the two sections, i.e. life extension and cure.
Life extension. Like millions of others, I was in the angio suite being told if I had one more attack, I very likely wouldn't survive it. My only chance was to have the vessel opened. It was the obtuse Marginal 1, half way down the LCX. I had received an attack each day for three days and they had got worse each time and from the pains of the last attack, I didn't doubt I wouldn't survive. The attacks were brought on by consuming food, and so I had 4 choices, never eat again and die, have another attack and die, or have a stent, or carry on with nitrates etc which were doing nothing. Millions of people each year are in a similar situation. After stenting the vessel, the pains stopped and it was great to eat without discomfort. So I think without a shadow of a doubt, that stent saved my life and of course extended my life, as they do with millions of people.
Cure. Well, during my last angiogram, the cardiologist had to look through my notes to establish where the stent is. He still couldn't see it, but he pointed to the area. There is no bulging or narrowing at all to give away the position and there is no disease at all in the LCX. If I carried on with bad diet and stress, then there is a good probability such good result wouldn't have been achieved. So nearly four years later, there is nothing bad developing in that vessel, so could we class it as a cure? I think so. Even being off plavix for 18 months caused no problems.
I'm sure there are some cardiologists who implant stents when not required, but they should have their ability to practice reviewed. The hospital I attend has no financial incentive for Doctors to install them. As a matter of point, at the time my OM1 was stented, the severe condition of my LAD was noted, but they left that vessel for further testing. He could have quite easily gone mad and put 6 stents in my LAD and RCA.
At cardiac rehab I met many people who had bypass surgery that had given problems and had to resort to stenting, which has greatly improved their quality of life. I know you don't think much of stents, but they certainly help millions of people all over the world survive, extending their lives.
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