Triple Vessel Disease--option other than CABg

[keceeyen]

Can anyone enlighten me on the  following report and can tell me the prognosis with medication only as I want to avoid surgery. Thanks in advance.

Patient History : 46 yr old male. Previous IWMI 9years back. TMT +ive. ECG-Q waves in L III
Catheterisation Report:
Coronary Anomalies : Nil
Dominance : Right
Left main : Normal and short
LAD : Type 3 vessel. Proximal LAD Artery after a small Diagonal is totally occluded.
LAX : Non dominant vessel. Early Obtuse Marginal 1  is a  large vessel with 50 % stenosis proximally. Left circumflex after AV grove is totally occluded. OM2 is a small vessel. OM3 is a good sized vessel and appears graftable.
RCA : Dominant vessel. Mid right coronary artery has 60% stenosis. Distal right coronary artery has 70% stenosis.
Distal Left Anterior Descending Artery is seen filling through collaterals from right.
Left Ventricle: (By Echo)- Basal Inferoposterior wall hypo kinetic. Good left ventricular systolic function trivial mitral regurgitation.
Impression : Triple Vessel Disease.
Advice : CABg.

[ed34]

Just watch the stress, it can affect your heart disease as much as anything else in the risk list. The walking every day is a good move, it's a great way to notice if the disease is progressing. I would make sure the walk is at the same time as much as possible so food digestion doesn't get involved and confuse issues, because it sure can. If you are unable to control your stress, perhaps asking your Doc for a low dosage of beta blocker would be wise. With such big changes in your lifestyle already, and if you get the stress controlled, then I think personally you will probably be in the same situation in a years time. Just remember, things happen whether you worry about it or not.

[keceeyen]

appreciate comments of both of U. I am an Ex-military, and now in the  process of being selected for a civilian officer job. It will take one more year for completing the formalities. Under going open heart surgery, till then, will render me medically unfit for the job.I was a smoker as well as a drinker for 25 years. Now totally stopped (for 3 months). STOPPED FOR EVER. No Craving at all now. I am worried not because of fear,but because of financial security of my family and children. Also i am doing 45 minutes of brisk  walk every day with out any problems (with normal medications). No oily food or beef. Moderate wheat/rice preparation  with fish curry. Ur comments please?.

[Flycaster305]

I totally agree with Ed34.  I avoided bypass surgery for about 12 years and agreed to only medications and stents.  The medications became invasive, and stenting is, in my opinion, often a stop-gap procedure.  I think Ed and i both had about eight stents, and eventually had bypass surgery.  Ed is about your age, so I'd listen to him carefully (I'm 71 years old).  Using arteries for bypass have about a 15 year life, so I'd factor that into your decision.  
Certainly, I'd make lifestyle changes regardless of your decision.  If you smoke or chew tobacco, stop.  I'd suggest quit eating red meat, and also discuss with a professional dietary consultant how to reduce cholesterol in your diet. If you are a type I or 2 diabetic, learn how to control it.  I'd suggest you mix in about one hour of exercise per day.  
Your procedure report suggests to me a need to have bypass.

[ed34]

You only have 2 other options really. The first is to hope medication/lifestyle changes stops the disease getting any worse, but there are no guarantees. No medication will remove the disease.
The second is to find a cardiologist willing to stent. However, looking at the amount of disease you have and the location within the vessels I doubt this will become an option.
If you are holding back due to fear, then you will regret this further down the line if your condition gets worse.

[keceeyen]

Hi ed,
Thank u for ur comments/ response. I have deferred the surgery for one month. Still on the look out for more opinions.

[ed34]

It would be very difficult to say whether medication + lifestyle changes would be enough to prevent the disease getting any worse. There are no guarantees. What concerns me the most from reading your report is that you are already relying heavily on collateral feeds from the RCA across to the distal LAD. However, the RCA is getting considerably diseased. Obviously as the flow in the RCA diminishes, it will give less feed into the LAD, having double the devastation. Your left circumflex is also considerably diseased, in particular, the marginal vessels.
Personally I would consider the CABG due to short/long term prognosis. If the RCA gets narrower, you could be in serious trouble. A part of your left ventricle is also hypokinetic, meaning it's slow to respond. I would take note of exactly where they intend to graft vessels onto, and which vessels they will harvest to take on the job. Sometimes more than one opinion on this is a good thing.