mild LAD stenosis

[Irene]

A recent angiogram has shown only mild (less than 50%) proximal LAD stenosis, and no treatment was advised for this. This was done because of symptoms suggestive of angina. Do you agree that this level of stenosis would not cause such symptoms, and that it should not be treated? (I also have a pacemaker because of SSS and have had a successful AV node ablation). I am not particularly anxious about this, although the symptoms are a little limiting at present.  Thanks.

[CCF-M.D.-RCJ]

irene,

Thanks for the post.

Never say never, but it would be very unusual (but not impossible) for a 50% stenosis to be causing angina in an otherwise notmal heart (ex: no aortic stenosis).

A syndrome called Syndrome X has been described in patients with typical angina and EKG changes but no significant angiographic coronary disease.  On MRI, these patients demonstrate myocardial changes consistent with ischemia.  The hypothesis is that these patients have microvascular coronary artery disease.

Consider having your angiogram seen at a large referral center to ensure that it was of high quality, and that nothing was missed.

Good luck.

[DottyCece]

Why did you have an AV Nodal ablation for SSS?  Did you have other arrhythmias as well?

Under what circumstances would an AV Nodal ablation be indicated for SSS?

[Lyn2]

DottyCeCe,
I haven't commented on board for a while, but just thought I would hop in here.  The doctor would obviously have a better answer, and maybe mine is not entirely accurate, but I have SSS and a pacemaker.  SSS can either cause the heart to beat too slowly, or it beats too slowly at times and too quickly at other times.  The heart rhythms that are fast come from the atrium, and could be a-fib or a-flutter or others.  The purpose of the AV node ablation would be to prevent the ventricles from receiving fast beats from the atrium.  Supposedly once you've had an av node ablation you don't feel all those arrythmias, although I must say I have heard contrary from people suffering from a-fib with an av node ablation.
Hope this helps.

[Irene]

Hi there
The comment from CN covers it quite well.  My arrythmias were not controlled by combination of pacemaker and large doses of medication.
Helen

[DottyCece]

It would seem to me that if one has an AV Nodal ablation the so called atrial kick would be lost when the atria are in fib or flutter and that would be a downside to this.  My sinus node dysfunction left me in bradycardia with periods of atrial flutter which convert nicely with cardioversion.  Since I had the maze procedure for Atrial fib, I am determined to hang on to my AV node function as long as possible.  I feel like I gave up some things to have the maze that I want continue as long as possible withour further ablation.  The sinus node dysfunction was 2ndary to mitral valve replacement.