Re: Follow-up arteriogram

Posted By CCF CARDIO MD - DLB on March 23, 1999 at 11:55:47:

In Reply to: Follow-up arteriogram posted by Linda on March 19, 1999 at 15:18:43:






: About nine years ago I developed unstable angina and an arteriogram revealed I had 75% blockage in near the top of my left main.  Since that time I have been treated with Cardizem, various cholesterol reducing agents - Lopid, then, Mevacor,now, Lipitor.  My cholesterol is currently below 200 and has been between 200 - 250.  I have had periodic stress test, and, last year, had a Galion stress test (due to some pain with increased activity and some shortness of breath) which did not reveal any ischemia.  My concern is if I had 75% blockage nine years ago, is that blockage increasing?  When would it be appropriate for my physician to perform a follow-up arteriogram?  I am a 53 year old lady, and am not currently having any cardiac symptoms.  I do am on estrogen replacement therapy.




Dear Linda
I am confused by your question. If you had unstable angina and a 75% stenosis of your left main coronary artery, almost every cardiologist I know would recommend coronary artery bypass at that time, unless there are extenuating circumstances. You should double check your information - I can't believe that you really had a 75% left main lesion that was not treated surgically.
Regarding follow-up arteriograms, I never recommend them. Unless a patient has symptoms and/or an abnormal stress test, I do not perform a cardiac catheterization. If you really had a 75% left main stenosis that was left untreated nine years ago, I do not know what I would do (though I would be skeptical of that piece of information unless I actually saw the catheterization film).
I hope this has been useful. I wish you the best of luck. Feel free to write back.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.   The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.





You have made me second quess myself;however, I am almost sure there was 75% blockage, and, in fact, while still in the room where the arteriogram was done, my cardiologist told me he felt they were going to have to do something about it.  Later, after consulting with some of his partners, he told me he felt it could be managed with medication.  I am going to confirm this information with him, but if I understand you correctly, so long as my stress tests are normal, they is no indication for an arteriogram.  My concern is - if, indeed, I had 75% blockage - what chance do I have of being one of those ladies who is going to just "drop dead" of a heart attack.  I really understand no one can answer this question.





Dear Linda
If you really had a 75% stenosis of your left main coronary artery, your chance of sudden cardiac death is quite high. To be honest, I would have expected it to have already happened in nine years. This is another reason why I am skeptical of the original information. Double-check this information.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.   The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.