Take a stent or wait for collateral growth?

[Angus son]

Dear Medhelp Forum,

A 45 year old male has RDA blockage at 70% There are no symptoms or discomfort during exercise at high end of 150 bpm. However the stress test echo showed heart function is being impeded by lack of blood. Will heart damage such as hypertrophy occur if this activity continues? Should I take another stent or wait 6 months for a collateral growth?

Best Regards,

[kenkeith]

Question: "A 45 year old male has RDA blockage at 70% There are no symptoms or discomfort during exercise at high end of 150 bpm. However the stress test echo showed heart function is being impeded by lack of blood. Will heart damage such as hypertrophy occur if this activity continues? Should I take another stent or wait 6 months for a collateral growth?"
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If there is an estimate of 70% blockage without any symptoms, the condition almost always can be treated with medication.  With the statement "heart function is being impeded by lack of blood" doesn't seem to be consistent with passing a stress test within the acceptable heart rate?

I assume your test included perfusion for some occlusion, and there was induced reversal ischemia.  Available treatment is to open the occluded vessel for better blood flow, and if the blood flow is seriously impeded there almost always are symptoms (chest pain, etc.).  If the vessel is dilated with medication, that may be sufficient...all 3 treatments (medication, stent, and bypass) only treat the symptoms and are not a cure.

Left ventricle hypertrophy can occur regardless of the therapy so it would be recommended to reduce the risk by proper diet, healthy lifestyle, control blood pressure, etc. Abide by a healthy lifestyle, etc. you may never need any intervention, and may not require any medication!.

One cannot rely on the probability of collateral growth as that condition is not a completely understood phenomon and unpredictable.  Six years ago, I had symptoms (CHF) from occluded coronary vessels.  The RCA was 98% occluded and stented, the 100% blocked LAD had collaterals, and an ICx was 72% blocked.  I do very well with medication.

[Flycaster305]

A 70% blockage is generally considered the point where stents are advised, and that's probably why you aren't experiencing symptoms like pressure or breathlessness.  Some people develop collateral arteries better than others, better meaning bigger.  I don't seem to have much luck with collaterals, even though I exercise daily.  I note you ask if you should take another stent... I assume you already have one or more stents.  

I would probably ask for an angiogram and a stent if needed.  A narrowed artery combined with a clot equals an MI in a New York Minute, I know from experience.  

[ed34]

You seem to be very sure that you will grow collaterals. Even if you have some collaterals developed, there isn't any guarantee that you will form more. Did someone tell you that you will form collaterals in 6 months?