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Triple Vessels Blockage without Symptoms

Suggest the best treatment for triple vessel blockages. Detail is as follows:

LMCA:    20-30% distal segment stenosis
LAD:       70-80% distal segment stenosis
LCX:        100% proximal segment stenosis
RCA:        100% mid segment stenosis


This discussion is related to Triple Vessel Disease.
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Avatar universal

I have tried to send you a copy of the angiogram. I added it as a picture. You should be able to see it if you hit my user's name TomCAD

You seem quite knowledgeable.

Thank you in advance
Tom
My e-mail incidentally is tom.***@****  
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Avatar universal
I am confused too
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976897 tn?1379167602
Obviously we can't see the diagram but it does look as though you have a fair bit of disease going on. The left coronary artery (LCA) is the feed for the main two arteries which feed the left side of the heart (LAD left anterior descending and LCX Left Circumflex) and according to the report, this is blocked 100% ?
It than goes on to say the LCA is blocked below the LCX (left circumflex) which means that the LAD cannot get a supply from the left main stem at all. So, this would lead to only one conclusion. It's obvious that the LAD must be getting a feed from somewhere or a vast amount of muscle would be dead, and to be honest (and sorry for being blunt) but so would you. You have likely developed the same situation that I had, where the LCX has forced open tiny vessels to feed across into the LAD. This won't be enough for normal life, and will likely give shortness of breath and angina on exertion. I'm confused quite a bit with this report tho. If the left main stem is blocked before the LAD, then how would stenting the LAD help? Do they mean stent the LCA?
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Avatar universal
Have had angiogram. Triple blockage: 100% RCA and LCA, 70% LAD between 12 and 13. RCA at 2 on diagram. LCA below circumflex, LVEDP: 25, LVEF  35-49% Surgical option recommended: graft of RCA or PTCA of LAD.
If I had a heart attack it was silent: I am a Type-2 diabetic.. The word hypokensis written on  diagram of RAO/LA0

Any comments would be appreciated

58 yr old male with long history of smoking
Thank You
Tom
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367994 tn?1304953593
LMCA:    20-30% distal segment stenosis
LAD:       70-80% distal segment stenosis
LCX:        100% proximal segment stenosis
RCA:        100% mid segment stenosis
________________________________________

The high degree of variability in coronary venous anatomy makes it important to have a uniform segmental classification system.  Because of this variation,  an analysis is required to identify what areas of the heart that are receiving or not receiving sufficient blood supply.
For instance occasionally, a coronary artery will exist as a double structure (i. e. there are two arteries, parallel to each other, where ordinarily there would be one), different tributaries, collateral vessels, wrap arounds, etc.

I had/have insufficient blood supply to the anterolateral papillary muscle (area where some chords that attach to the mitral valve are located) and damaged (ischemic) caused moderate to severe mitral valve regurgitation.  That heart muscle  more frequently receives two blood supplies: left anterior descending (LAD) artery and the left circumflex artery (LCX).  It is therefore more frequently resistant to coronary ischemia (insufficiency of oxygen-rich blood).
If the papillary muscles are not functioning properly, the mitral valve may leak during contraction of the left ventricle.

Unless there is a variation to the normal coronary configuration, it seems the 100% occluded LCX and and 70-80% LAD would not be adequately supplying blood to that area and that could/would cause mitral valve regurgitation.

Just listing degree of occluded valves does not provide any information about the anatomy of coronary arteries, perfused locations or lack thereof.  It is difficult to believe you have those blockages without variations from the normal blood distribution. Do you have more information?
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237039 tn?1264258057
What option has your doctor suggested? You must have had a reason to have the angio.
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159619 tn?1707018272
COMMUNITY LEADER
Yup, don't know why I didn't see that, thanks Ed..................
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976897 tn?1379167602
I'm a bit confused as to how you had an angiogram done when you have no symptoms?
Erijon it says where they are blocked, proximal and mid segment.
I really don't think there's enough information here to evaluate your best option. I would be very interested to know how well your heart is performing and why you have no symptoms.
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159619 tn?1707018272
COMMUNITY LEADER
It really depends on where the LCX and RCA are blocked. This looks like a triple bypass to me, but I'm not a doctor.

Good luck,

Jon
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