Triple Vessel Coronary artery Disease.

[Gopin30]

Hi,

My father is 62, and had giddiness and throat pain while climbing a hill. We have consulted a cardio specialist in my native and as per his advise, ECG, had been taken,. As it was abnormal, he has been advised to go for echo and angiogram.

As per Angiogram, he has been recommend to by pass surgery for triple vessel disease.
Please find below the angio gram result:

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LMCA : Normal

LAD    :  LAD is a type III vessel. Proximal LAD has eccentric 30% lession. Mid LAD has long segment eccentric 80% lesion. Distal LAD has 70% lesion. D1 had ostio-proximal 70% lesion. D2 is normal. S1 has ostio-proximal 70% lesion. Other septals are normal.

LCX    : Non Dominant vessel.OM1 has ostio - proximal 50% lesion. LCX after OM1 has 50% lesion. LCX after OM2 is totally occluded.

RCA    : Dominant vessel. Promal RCA has mild disease. Mid RCA is totally occluded. Distal RCA,PDA,PLV are visualised through heterocoronory collaterals from LCA.

LIMA is normal

Final Diagnosis: triple vessel coronary artery disease.

Recommendation: CABG


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Please suggest me by pass surgery is necessary?
Some doctors has suggested that even by pass surgery will not be that much useful for him.

Please suggest me whether medication would be enough for him?

He is a diabetic, BP patient. (both are always in controal and medivation).

Please give your suggestion......

Thanks.

[ed34]

Well Chelation is something which apparently doesn't do anything for artery disease. However, ECP has been getting very good results. The technique seems to force the heart to open up collateral vessels giving more feed into heart tissue. 35 treatments is the standard but some patients have to have a 'top up' after a year or so. Still progress with the lifestyle changes to slow down progression of the disease, or even stop the progression because the collaterals still get their feed from the coronary arteries. Please keep us informed about this because it's very interesting and I anticipate good results. It has been approved by the FDA so all cardiologists should be aware of it.
Here's someone having ECP
http://www.youtube.com/watch?v=gqrNnPAR5Os&feature=related

[Gopin30]

Thanks ed !!! Now My father is in treatment with non invasive bypass treatment called "ECP" External Counter pulsation along with chelation(EDTA). he has to undergo 35 sittings. It has been told by the doctor, It will by pass the need of bypass surgery and we have opted for it.

Can you you please let me know any ideas about these treatment. Many of them are not accepting this as an effective treatment and and many are unware about this.
Can anyone clarify me on the same. Does this will have any side effects?

thx,
Gopi

[ed34]

We are not Cardiologists, but if this was my heart I would be a bit concerned. Not because of its condition, but more that they are making decisions on very little information. The three main Coronary arteries and branches have a substantial number of high percentage lesions, so to establish the right ones for bypass would be very difficult. It would be an educated guess. I would insist on another angiogram first, one which this time they use an FFR sensor. Its a tiny sensor on the tip of the catheter wire which measures flow and pressure differences across blockages. Using this, they can immediately tell (accurately) which lesions should be treated for a big health change. In reality, although there are many lesions, it could be that only one single stent is required to fix things. It is common to have throat discomfort when the LCX is blocked, so I'm guessing big improvements would be gained from having this removed. Are there no cardiologists in the hospital who can remove blockages and insert stents?
The information above only outlines where the blockages are, how large they are, BUT what it doesn't tell you is the impact each one is having. Also, when some cardiologists are disagreeing with the decisions of others, there is usually something not quite right.  The RCA although blocked, is being fed from the left side and this is fine. Medication COULD work, but it's something you have to try and see, nobody can tell you if it will or not.