My husband had a stress test followed by a heart catheterization and was diagnosed with 2/3 blockage of his LAD artery and also blockage of the cirumflex artery. His doctor said he did not stent because of the size of the blockage and could not do CABG because of the location of the blockage (he said there is nothing to bypass to). His ejection fraction at time of catheterization was 35%. Was put on Coreg 3.125mg bid and lisinopril 2/5mg at night. My question is how should this be treated? What if disease continues up the LAD and there is complete blockage? Can meds alone treat this? Should I seek second opinion?
AHA/AAC guidelines do not recommend an interventional procedure if the blockage is less than 70%. The exception would be if medication does not control symptoms (angina, chest pain due to an occlusion).
I have totally blocked LAD and a 72% occluded circumflex for the past 6 years. My EF was 13 to 29%, enlarged left ventricle, and stented my RCA 98% blockade. The LAD over a period of time had developed collateral vessels that naturally bypass the blockage.
Your husband is receiving the same medication as I do/did, and that medciation reduced the heart's workload by dilating vessels. This helped the enlarge heart to return to normal size and current EF is 59% (normal EF is 55-75%).
In addition to the medication you list, there may be lipid control medication, exercise, healthy diet, healthy life style, etc. That may prevent any further occlusion of the LAD, and medciation to control blood pressure (ACE inhibitor (lisinopril) and beta blocker (coreg) can return to the heart to normal functionality. Within months, the medical therapy can be evaluated and you don't need another opinion.
I don't have symptoms, but I take a nitrate prior to an exercise workout to prevent angina.
The medical community knows the 3 options to treat are medication, stent implant, and bypass only treat the symptoms and not a cure. So if you husband's therapy effectively treats symptoms that is effective therapy.
Kenkeith has said it all basically and given great advice.
I wonder though if you might have the information to answer a question for me. When they say "there is nothing to bypass to" did they give further details of this? Is the blockage right near the bottom of the LAD? or are they saying there is a substantial coating of plaque all the way down the LAD?
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