Left Chest Aching After Exercise

I am a 49 YO Male who suffered an MI 7 weeks ago, the morning after hiking at 9,500'.  In the ER the attending physician remarked that the EKG looked as if there was an old heart attack.  I had been denied life insurance a few years because of a similar EKG interpretation, so I believe that this might be my second MI.

A subsequent angiogram showed a 100% blockage midway down the RCA, which has developed some collateral vascularization.  A 50-65% blockage was also found near the beginning of the circumflex, but my left coronary was clear.  The RCA blockage couldn't be entered for angioplasty and the circumflex wasn't fixed either.  

My HDL / LDL ratio has always been out of normal limits and total cholesterol was 217.  My mother had three heart attacks followed by bypass surgery at 57 and died at 64 of heart failure.  I don't smoke but weighed 245 lbs last winter and made no attempt to limit dietary fat.

My myocardium seems to only have a small amount of damage near the RCA blockage and I believe I have an Ejection Fraction of > 70% during the angiogram, although I wasn't sure of what my cardiologist was referring to when he said that their heart function scale was 55 - 70 and mine was 70.

The cardiologist later told me that the blockage is probably very old and that the collaterals are giving me an approximate 20% of normal blood supply to the affected portion of the myocardium.  Subsequent stress treadmill / ultrasound show that I have significant capacity to work, but the muscle beyond both blockages indicates ischemia at full load.

After conferences with both the cardiologist and a cardiac surgeon, either a stenting of the Circumflex and a minimum invasive bypass of the RCA or a CABG to bypass both blockages were suggested as an elective treatment.

After study, it wasn't clear to me t

[CCF CARDIO MD JMF]

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