My father (69) had gone through cath stent in 1997 and then bypass surgery at 2006 .
A month back he was detected of block in main artery by 80-90 % ? His cardiologist suggested Medical management instead of Stent ? My question is can medication solve his cardiac block or eventually we have to do a Stent surgery ?
I'm sorry to hear about your father's problem.
Questions come to mind, this is a difficult question to understand without lots of information.
Is the block in the LAD (left descending artery)? Also, is this the artery that was bypassed? Other questions would include his weight/blood pressure/diabetes control/smoking histories. Also, is he experiencing breathlessness and/or angina?
I'm sorry your father and the family is going through another round of cardiac stress. More information would be helpful. Keep us informed.
Thanks for your response . Answers to your questions .. yes LAD ,weight : 62 kgs(137 lbs) , bp 130/80 , 110 fasting , 120 Post food (PP) . Yes he was experiencing breathless ness and that was the symptom when he visited the doctor. Now it is comparatively less . No angina.
These are the few lines of CT angiogram summary that my father read out tome over phone :
MSCT coronary angiogram reveals absent/poor flow in LIMAgrapht . Venousgrapht D1 ,OM1,PLVB and PDA are patent. More than 50 % stenosis at the LAD austium.
Using medication, stents or bypass have no guarantees for outcome. A bypass can last weeks, as can a stent. So, intervention isn't always the solution anyway. I think that it's becoming far more common now for cardiologists to assist the heart in developing its OWN resolution. The heart can open collateral vessels to form a natural bypass and if there is a good enough flow/pressure in one of the coronary arteries NOT blocked, then this is likely to open those vessels. Why do this instead of stenting or bypass?
Well, in lots of cases, patients obtain a great flow through re-opened vessels using stents or bypass, yet feel the same angina, or even worse. Looking at the angiogram images it isn't clear why either. A classic example would be a patient who goes to hospital with heart attack. They are rushed into the angio-suite and the blockage is seen and stented. Other blockages are seen which are 70% or more, and these are stented too. The patient and the cardiologist have no idea why, but they feel much worse than before the heart attack. This is because lots of collaterals will have closed up again due to the blockages being removed. You can't see the tiny vessels on an angiogram, and you can't see which tiny vessels are blocked requiring those collaterals. opening a big artery is not always the answer, there could be hundreds of tiny vessels which are blocked and relying on the opened collaterals. From everything I've read over the last 5 years and all the patients I've met in my many visits to hospital, I have the firm belief, if there are no symptoms, leave things alone. Nature has dealt with it. However, there can be exceptions to the rule which is where you have to think things through a bit. Lets say for example there is a blockage of 90% in the LAD and 90% in the RCA. The Left Circumflex has a blockage growing, and is currently 60%. The patient has no symptoms. Now, it's obvious there MUST be collaterals, or symptoms would be felt. From the angiogram it's obvious that the collaterals must be fed from the Left Circumflex, it's the only vessel with enough flow/pressure to open them. So basically, the patient is alive due to ONE vessel. If this blockage reaches 70% or higher, it's likely that all the collaterals will close and the patient will be lucky to survive. Personally I think there should be at least one clear vessel at all times so in this case I would have the Circumflex stented, and probably pushed open wider than it normally would be.
The confusion as to why so many patients feel worse after intervention is still unanswered. Some say it's the trauma to the artery, caused by the stent crushing the plaque into the wall. They are now looking at stents which dissolve over a period of months, to help with this problem, even though it isn't known if it IS the problem.
On a last note, it isn't always the size of the blockage which matters. Policy says anything over 70% should be stented or bypassed, although some cardiologists have woken up now and realise this is nonsense. There is a catheter with a tiny sensor which can give readouts of blood flow/pressure etc at any position in a coronary artery, so you can see the effect a blockage is giving. It has been noticed on MANY occasions that a 20% blockage can have far more effect than a 70% or greater. Last year I was given 2 stents because the flow down my Circumflex dropped off by 50% halfway down. There was nothing you could see on the screen, it looked really clear. After stenting the flow rate was the same all the way down. So, microscopic irregularities caused a 50% disruption and without that sensor, this would never have been found. So size doesn't matter in this case.
You can tell from an angiogram in many cases if collaterals are helping a vessel with a blockage. Even though you can't see the collaterals, you can see how much blood is on the opposite side of the blockage. My LAD was 100% blocked at the top, and halfway down it was showing blood but it was retrograde filling. On the angiogram you could see the blood flowing UP the vessel instead of down. A vessel could be wide and fully patent after a tight blockage, that blood must be coming from somewhere.
Anyway, I'll get off my soap box now and I hope I've given you plenty to think about. Sometimes intervention isn't the answer, but you need to evaluate your decision based on all the information available. Intervention can make things worse if the decision is wrong. It sounds like your Cardiologist is of the new camp and knows what's best.
Sorry, that was long winded, let me give a short answer.
No, medication cannot solve a blockage. Medication helps with symptoms but blockages stay. However, the heart can solve the blockage problem by opening natural bypass vessels on the heart which can take a bit of time.
Ed34's answer is very complete, and I agree that doctors are more apt to try to get a patient with vessel blockage to develop collateral arteries that will form natural bypasses than they were in the past, and they use medications plus urge exercise and diet to accomplish these goals.
I've had heart attacks and multiple stents over the past twelve years, and last year I started experiencing increasing breathlessness and angina. Drugs like Ranexa and Coreg were increased and I was urged to continue to exercise, but a followup angiography disclosed I simply wasn't developing collateral arteries. It could be my age (70), because I have diabetes, but I finally had bypass surgery.
The last line of your notes suggests that perhaps there is a blockage in the
lad in the Osial position, probably at the first diagonal takeoff. This is a difficult area to stent, and I wonder if that is a factor. Keep in mind I'm not a health professional and may be mis-reading this.
If your father is active, I'd suggest he carefully continue to exercise and monitor how he is feeling and breathing, and report any change at once to his doctor. You dad should keep nitro tablets or spray with him at all times. Keep us informed.
Your response really a good insight into this matter . I have gone through your reponse multiple number of times and gives me enough confidence to call my dad and say "your cardiologist is good". Thanks Ed34.
my father is 67 years old. Doctors detected 3 block arteries (one is 100% and two are more tha n 90%)and sugested nothing but excercise. and also told us bypass surgery will bring more complicacy to his life and also risky for him. he has got high pressure and diabetic as well. though are in controll. would u please tell me a right solution or any medecine which i can buy from uk (Where i live).
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