angiogram necessary

what does reversible anteroapical  wall defect mean in laymen terms and is a angiogram necessary

[Flycaster305]

I believe that this means that there is an area of the heart that isn't getting oxygen like it should, but appears that it could recover, probably with a combination of drugs and exercise and diet.  I'm betting this diagnosis is a result of a stress test, and yes, I'd certainly have an angiogram to verify or disprove the diagnosis.  Angiograms sound much more invasive than they are, they are a very safe way to get answers as to the condition of your heart arteries.  I've had the procedure six or seven times, the most difficult part is keeping your leg from moving afterwards for 5 or 6 hours.  
Keep us informed.

[ed34]

I'm confused how they can make that diagnosis without either a ct scan or an angiogram. But flycaster is spot on.  

[Helenchein]

Thanks for the info. An angiogram has been suggested more then likely I will have the proceedure, As someone said keeping still for several hours is the hardest part. My results were from a stress test,which I was able to do physically  without pain, at the end I was out of breath but not breathing laboriously. If I could resolve this problem without surgery I would. Can that happen? Thru excercise and diet?  

[ed34]

Your symptoms sound minor for angina and medication should make a huge difference. The hard part is getting the disease under control, preventing it from getting worse. How is your cholesterol? A healthy diet will make a huge difference but so does avoiding stress. High blood pressure should be avoided as much as possible so you have to learn to chill, eat healthy and exercise. Then with the medication you should be there. If they find a blockage in an artery 70% or higher, they will recommend having it stented. This could be done during your angiogram.
You have to also consider the psychological issues. If you don't have the angiogram, you will always be wondering how bad your arteries are. Every time you feel a discomfort you will be wondering if it's your heart. For a quick procedure you may want to consider your options very carefully, for peace of mind.

[kenkeith]

Yes, a perfusion stress test will indicate reversal of induced ischemia (lack of blood flow) with exercise and then a rest period.  If you completed a stress test, and simply short of breath, that would indicate you are in fairly good physical condition. Anteroapical wall defect is located at the front wall at the upper portion.  There is an assumption that area has some blood blockage.  But a wall defect can be for other reasons!

Before you submit yourself to the intervention of a cath, you should be told the degree of blockage and any other medical options. If you have angioplasty, establish before the opertation whether or not you want a stent implant(s).

Generally an angiogram and stent implants are required if symptoms cannot be controlled with medication.  The downside once you have a stent, you become vulnernable to blood clots and need plavix for a year or more, and there is evidence the medication may be needed for a lifetime to prevent clots that could be fatal.  I have a 72% blocked coronary vessel and a completely blocked vessel, and I do well with medication...others have the same experience but don't voice their opinion because the forum attracts individuals with a medical problem and the forum opinion is biased.

You certainly have the option to forgo angioplasty if your symptoms can be controlled, but you have not provided much information, however, you should discuss the matter with your doctor.  And there is some evidence that coronary artery disease can be reversed with medication, diet, etc.

I'm not discounting what flycaster has said, and there is very little risk or major discomfort...
That was my experience 6 years ago as well.

[Flycaster305]

This is an interesting thread.  I tried to avoid stents and medications for several years after my first 70% blockage was diagnosed, and lost a lot of weight, reduced my stress level, exercised daily and went on a tight low cholesterol diet.  Like Kenkeith alluded to, I'm one of those persons who simply can't get the small vessels to carry the load and grow, and the medications and stents became absoutely necessary.  I feel had I taken statins, beta blockers earlier I wouldn't have gotten into the mess I got into: three heart attacks, eventually eight stents, an enlarged heart, and now a pacemaker.  There is no right or wrong answer on these forums, simply sharing our experiences.  

This is heady stuff, but to simplify, I'd start from square one and get a lot of information, and put aside preconceived notions.  Most importantly, get a good doctor and listen to him or her.  Best wishes.

[ed34]

I agree, what 'seems' to be ok for one, is not necessarily the answer for everyone. At the end of the day if there's a blockage 70% or higher, there are just four choices and they are (in real basic terms)....

1. Close our eyes to the problem and do nothing
2. Make lifestyle changes and do nothing else
3. Take medication and leave the blockage, hoping it will never rupture, possibly fatal
4. Have intervention surgery such as a stent to remove the risk of rupture.

All of the options may leave the patient with symptoms but only option four deals with the biggest problem in most people, the psychological problems. Knowing your blockage has been treated seems to lower anxiety levels in a lot of patients. Worrying if you will wake up tomorrow due to a rupture is a thought that never goes from many minds.
When making up your mind what option to take, you have to consider them all very carefully before making a decision. If option four isn't the best solution then I have to question why so many stents are implanted. Why dont they simply send heart attack victims home with medication? Personally I hate nitrates and I would rather put up with severe angina than take that stuff. The headaches are quite nasty and if you have severe angina you have to keep squirting it under your tongue and get more headaches. Is that a good quality of life? These are questions we need to answer to come to our decision.

[kenkeith]

I didn't have you in mind or anyone specific when I stated the OP should be aware of the options and discuss it with the doctor...I was pointing out patients on just medication is not fairly represented on this forum and any view would be biased as we are strongly influenced by our own experiences.

It seemed to me, Helen, was reaching out on this forum for alternatives and her symptoms were/are slight.  I have read thousands of posts and there are very few that have an angiogram for suspected occlusions that does not get a stent during the procedure. The cardiologist may see a 60 percenter, and stent for whatever reason even for the money!  The stats indicate there are many patients that receive stent implants who may have done well with medication therapy.  I would never suggest you or anyone should have relied on medication and not have stent implants.  One may or may not have known there are options, I didn't know the options 6 years ago and had a stent implant.  Now I'm concerned there could be fatal clots (off Plavix), stenosis worse than before the stent, etc. and require a bypass.  When on medication for ischemia one can always go to a stent implant if necessary or CABG.
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Suggested options for occluded vessels that don't not make much sense to me.

1. "Close our eyes to the problem and do nothing".
>>>There isn't anybody suggesting stupidity is the answer, just options.

2. "Make lifestyle changes and do nothing else"
>>>Medication, diet and exercise, etc. would be the recommendation for some patients.

3. "Take medication and leave the blockage, hoping it will never rupture, possibly fatal"
>>>>The danger of occluded vessels is ischemia and heart failure.  There are fewer heart attacks from occluded vessels than from the rupture into the lumen caused by soft plaque.  A DES stent implant may increase the probability of ruptured soft plaque and heart attack.

4. Have intervention surgery such as a stent to remove the risk of rupture.
>>>>There is no reduction of risk for a rupture, and that is an important point!.  In fact it may increase the risk of clots with DES implants, therefore, some doctors are prescribing  Plavix for a lifetime...that's medication that could  be avoided without a stent.  Stented implants open vessels for blood flow to prevent ischemic heart failure and treat the symptoms and it is not a cure.  The good doctor on the expert forum pointed out meds, stents, and CABG only treat the symptoms and is not a cure...life expectancy is not an issue regardless of the therapy.

Heart patients should be aware of the options.  No one other than the treating doctor has relevant information to make decisions, but the patient should have an active role in deciding on options with some knowledge of the medical alternatives.  Unfortunately, few patients know the alternatives available.