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cardiac disease
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cardiac disease

my brother age 50years having a heart attack few weeks ago,he was hypertensive but not takinig medicine regularly to control the blood pressure,after heart attack he was gone through the cornary angiography procedure,and get the final diagnosis 3VD with mild LAD disease, Normal LV function.

E.F%:>55     Dominance:Right
left main CA - Normal

LAD:- MID LAD WITH 60.25% TUBULAR STENOSIS

CIRCUMFLEX:- FIRST OBTUSE MARGINAL WITH 80% STENOSIS.Severe 80% stenosis in proximal part of good size OM1.

RIGHT CA:- DISTAL RIGHT CORNARY ARTERY WITH 99% STENOSIS.SUBTOTAL 99% DISTAL OCCLUSION WITH TIMI-II ANTEGRADE AND FAINT RETROGRADE COLLATERALS THROUGH LEFT MAIN.


HERE i have given the detail report of angiography.now doctor advice after one month of this report that patient is required to go through bypass surgery...(CABG) kindly,suggest us either our patient should go through this surgical procedure ,or there is any alternative to this.

reply as soon as possible.  
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14 Comments
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976897_tn?1379171202
I'm looking forward to reading the reply on this one because I'm wondering what procedure was done to stop the MI? If someone is having a heart attack, I didn't think it would just go away unless a) collaterals formed to give blood supply, or b) intervention of stent or bypass was performed to open blood supply or c) a clot had formed and had broken down on its own.

It's obvious from the angio report that the circumflex requires treatment at 80% and the RCA is  developing collateral feeds. Is it worth a bypass procedure if collaterals are forming which are natural bypasses formed by the body?

If this was my body I would probably ask why they can't stent the Circumflex and leave the rest to lifestyle changes and medication. Do you have any echocardiogram results? How bad are his symptoms now?
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242509_tn?1196926198
It sounds as if the cause of the heart attack was the RCA. This does not appear to have been stented, or even balooned. He has significant disease in the two other major arteries in the body, and his dominant RCA circulation depends on that of the LAD. So I would say that he probably will have a better outcome with CABG versus drug coated stents, but stenting, of performed at a high volume center by an experienced operator may have the same effect with less up front risk.
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Avatar_f_tn
i hav his  echo report interpretation is like this;( 1)hypokinetic epical mid IVS and anterior wall.(2) REmaining segments are showing normal contraction .(3) moderate symmetrically hypertrophied normal size LV,with mild to moderate dysfunction .(4)normal size RV. (5)NORMAL PULMONIC AND TRICUSPID VALVE.(6)NORMAL MITRAL AND AORTIC VAVE.    EF;40% TO45%  The condition of patient is ok he is doing his work riding bic and clambing stears 20 to 25 and avoding salty and greasy food and taking medicine he has no chest pain complain since last attack. plz reply soon
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Avatar_f_tn
the MI was stop by giving IV infusion of Streptokinaise.
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Avatar_f_tn
Yes he has nt gone through the angioplasty procedure,he was given only Strep.kinase injection at the time of heart attack.now he is doing well and has no any chest pain on walking or even on climbing stairs and also he is doing  daily life routine work..we are affraid of CABG because of lots of problem like bed ridden for longer period and other complication of the operation.so kindly give your advice for any other procedure beside CABG.
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Avatar_f_tn
if you want to see the angiography cd so i can send you that to.
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Avatar_m_tn
Your brother sounds like my case.  10 yeas ago, when I was 50, I was hospitalized with with and M.I.  Angiography showed a 100% occluded RCA with a 90% ostial blockage of the circumflex and some other abnormalities.  The RCA had developed some collateralization.  They failed to cross the blockage in the RCA and couldn't open it and I was referred for bypass surgery.  Also was told that I most likely had prior M.I.s and I can remember having my first event like that when I was in my 30's.

I was referred for CABG surgery but decided against it.  I had motivation for lifestyle change and started eating greener and leaner, walking and hiking daily, and taking vitamins and supplements.  I read research at the time that aggressive cholesterol therapy could stop the progression of the disease, and got on a statin drug immediately and supplemented with high dose Niacin and another drug later.  Also got my BP under control with a two drug combo.  The main thing in my case was raising my HDL from around 30 consistently into the 50s.  I have maintained a perfect lipid profile these ten years via the drugs.

A second attempt at angioplasty a year and a half later was also a failure.  Then it was discovered that I had a previously unseen plaque in my left main that had ruptured and lost it's contents since the last look.  The good thing was that my RCA blockage was not fully collateralized.  I was referred again to bypass surgery and given a 40% chance of dying within 5 years if I didn't have it.  I chose again to go with the multi-drug therapy coupled with daily exercise and the other changes.

Early on I also took about a 45 day round of a frontline antibiotic with the goal of killing the bacteria in my arterial plaques.

10 years later, I'm still doing fine heartwise, but sometimes it really amazes me, because I have really abused myself with food and alcohol in the last years.  I'm trying to correct that now.

I'm very active.  Into skiing, snowmobiling, and off road motorcycle riding.  I had a arrythmia problem recently, but found that it was a vitamin deficiency.  Other than that, I feel like a normal person and don't worry much about my heart.

I would say that your brother is one of those people who have survived some prior cardiac events and has grown some collaterals in response to ischemia.  He is a good candidate for aggressive cholestoral and BP therapy.  He he is motivated to eat better, exercise daily, reduce stress, and do other lifestyle changes, his outcome will be better than surgery.
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Avatar_m_tn
Correction:  My RCA is now fully collateralized.
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212161_tn?1391090750
awesome out come always great to see there are things we can do other than going under the knife. keep up the good work.
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976897_tn?1379171202
So when they discovered you had ruptured plaque in your artery, you got away with a very lucky escape because you could have had a nasty stroke or a fatal heart attack. However,
that would still have probably occurred even if you had gone for the bypass option.
I watched a video recently online of a patient having plaque removed from leg arteries. Laser was used and it was amazing to see the difference in circulation. It was all done using the angioplasty catheter wire along with tools. I often wonder why this can't be done to coronary arteries, at least the main vessels, to give us a big head start in life style changes and quality of life. Even some kind of chemical to break down the bonds of the plaque and fats would be a good thing. Surely a chemist somewhere can come up with a substance which can be injected through the catheter into vessels, breaking it all down. If HDL lipids breakdown the unused fats, I wonder why they can't synthesise these, or grow them in a lab somewhere. We could be injected with high doses over a period of time for a good clean up.
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Avatar_m_tn
On the second shot at angioplasty, when the ruptured plaque in my left main was discovered, the attending cardiologist and myself had a different opinion on the root cause and the level of risk.  

This plaque was an extension of the defect at the entrance of my circumflex and very near to the branch.  It was completely devoid of it's contents and the remaining crater walls were flapping in the blood stream with every pulse.  The cardiologist looked at it as doom, but I looked at it as success.  I'm pretty sure that it popped when I climbed Mt. Adams that year, as it felt like it that evening.

I saw that broken plaque, with no remaining contents, as the result of successful lipid therapy.  The plaque completely dried out and the cap came off as a result of hydraulic forces in the artery.  Of course there were going to be some remnants for a time.  The doc's argument was that the cap could reform and kill me.  I ask, if so, why it didn't kill me the first time?  He didn't have an answer that sounded logical to me.

Yesterday, a young friend and I rode out dirt motorcycles up a nasty trail to the snow at about 5,000 feet and then walked another mile in the snow.  I wasn't limited by angina although I'm currently 60 and overweight and wouldn't say that I'm in great health.  I really need to work at saving my life one more time, by getting a grip on my alcohol, getting green on my diet, and getting back into walking uphill every day.   If I croak, it's not because my choice of treatment for CAD was wrong, just that I couldn't/wouldn't change my bad habits.  Good luck.
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Avatar_m_tn
As to the laser therapy.  I nearly went to a cardiogist in Canada 10 years ago who was using a laser in the coronary arteries only approved in the U.S. for peripheral artery treatment.  I sent him my films and he would have done it for $3,500 (cash) U.S. at the time.  But there is risk of perforating the artery and I just didn't feel that bad over the blocked RCA so I chickened out.   Since then the artery has build a terrific collateral network which supplies the bottom of my heart quite adequately.  I haven't followed developments in laser or other angioplasty since, as, heartwise, I feel quite normal.
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