Possible second cath and stent in 2 months ???

[slowasaturtle]

I had chest pain, arm pain, tooth pain, elevated troponin, diagnosed with ST elevation with ischemia.  Had cath, one stent placed in circumflex which was 100 % blocked, cath showed 3 other suspicious arteries, one very small one 100%, too small to stent, one 40% blocked and the right coronary artery 50% blocked.  Have had ongoing bouts of chest 'pushing' feeling since hospitalization. Had stress echo on Friday, it was abnormal with chest pressure with EKG correlation. Showed that right coronary artery to be 60-70% block, not the 50% they saw on cath.

My question; they were in my heart during cath saw 50%, how come they didn't see it at 70% that they saw with stress test... I think thats a lot of blockage not seen.  We decided to treat with 'more' lopressor and a new med imuran, a extended release nitro... wait and see... my other option is another cath to stent the RCA... I really don't want another cath if meds work, but anxiety about thinking about blockage is frightening... Any words of wisdom out there ?

[kenkeith]

About 5 years ago, I had had a silent ischemiac heart attack and ICU for 3 days with congested heart failure EF 13-29% and lung edema.  I gave permission for a cath and it showed RCA 98% blocked (that was stented), 100% blocked LAD (that lesion was/is bypassed naturally be collateral vessels and the circumflex was/is 72% blocked (no stent).

The general authority AHA/AAC guidelines are:  Blockage less than 70% (there are exceptions).  Blockage greater than 70% treat with mediation (nitrate), if angina can not controlled with med, then stent.  If the lesion is unabled to be stented, due to size, location, etc., then a bypass may be the best option.

With medication, I have not had one day of any medical problems since being dx'd and taking medication.  I vehemently disagree with the other poster who advises intervention based on her mother's condition!.  

You may want to google (COURAGE study) and you can get a view based on statistics of the different treatment options (bypass, stent and medication) and you learn there is nostatistically difference among the options regarding longivity, etc.

[Encephalomalcia]

If the right coronary artery is 70% blocked it could spasm and therefore cause a heart attack from a blood clot.  The nitro is very bad for the liver.  My uncle and grandmother both died from cirrohous of the liver due to nitroglycerine.  Are you on a blood thinner?  If I were you, I would seriously look into having another cath and getting that artery stented. The blockage will just keep building and sometimes it does not take all that long to plug up to 90 or 100 percent in some people. My mom plugged up severely in only 3 years.