Monitoring CAD

Dear Doctor: I am a 60 year old male that had 2 vessel bypass 7 years ago after 2 newly implanted bare metal stents failed and also had a stent three years ago which is apparently doing well(coated stent). I recently had a stress echo from a new cardiologist as my old one retired who would use a non-nuclear stress echo to monitor my condition.  My old cardiologist said my stress echos are always abnormal but still useful (I have a LBBB and some angina on exertion and diffuse blockages).  So it has always been a challenge to monitor me non-invasively which is what I want. My new cardiologist last week did a stress echo and said it was abnormal and wants to do a cath and perhaps a stent. I questioned whether it was necessary. He said while my exercise level was impressive (about 10 minutes) and the right side of the heart showed good perfusion (which is where the last stent was), the front of the heart was slightly different that earlier echoes.  He thought while the cath may not show any descrete blockage that can be stented as I have diffuse blockages, he thougt it may reduce my mild angina symptoms (in my right bicep/shoulder) if they do find something that can be stented.  My angina has improved greatly over the years and doesn't limit me except under considerable exertion.  I follow the Ornish diet and exercise regularly by walking.  Do I really need a cath or are symptoms a better gauge?  What is the best way to monitor my condition? Is there an alternative to a cath for me- calcium scan, 64 slice?  I obviously don't want to always be in a position where a cath is the only way to see what is going on.  I take an ace inhibitor, beta blocker, zocor, plavix and a calcium channel blocker.  Any suggestions for medical management like changes in meds?  I appreciate any help you can give.  Thank you.

[Cleveland Clinic]

It depends on how limited you are by your symptoms. The stenting of any vessels in your case will only help to alleviate symptoms, not to prolongue your life span. So the answer to should you undergo the cath or not rests solely on your assessment of how severe or limited you are by the chest pain. The cath and stenting will not prevent any further development of heart attacks.