80% stenosis

[majedzak]

I am a 52- year old mail patient with a pmhs of HTN, dyslipidemia underwent a stress test secondary to dyspnea: ran 10 mins, no c/p, with mild ECG change.
LV Angio : normal size and function with an estimated ejection fraction of 60%
L Main: Angiographically normal
LAD: Proximal LAD bifurcates into 2 LADs: first one has an 80% stenosis and is occluded distally after that with left to left collaterals from its diagonal branch. Other branch gives septal branches and almost reaches APEx
CX and OM: mild mild disease, at the very distal OM2 there is a 90% stenosis with a small distribution distally.
RCA: Co- dominant, mild proximal disease, moderate distal disease, 90% proximal PDA
Please advice me how danger my situation is?

[majedzak]

Thanks for your reply ed34, my cardiologist recommended medical treatment at this phase, next month's I will have a stress test (with nuclear medicine..Something like that) I am now following a strict diet to decrease my weight ( over weighted), and I have increased my physical activity

[ed34]

Your blockages are high risk for rupture, which can cause stroke or heart attack. Once a blockage is 70% or greater then the risk for angioplasty becomes less than the risk to your health. My personal decision was based on several factors, not the least being your age. You are only 52 and you don't want those blockages to become 100%. There is no guarantee that meds will stop the disease progression. I am assuming that you have symptoms or else the angiogram would not have been done. The choice is obviously yours, because it's your body and no one can force treatment choices on you. I'm just trying to think more long term, than the next couple of years. If any of those blockages become 100%, then it would make stenting far more difficult because a thin wire has to be pushed through the hard plaque. Usually such circumstances are a reason why bypass is offered instead. I personally think that in a year or two, you will have no choice but to have stents or bypass, because your symptoms will worsen. I have been in your situation more than once. I had a 70% blockage in my left circumflex which they left and kept me on meds. Just three months later it was 99%. I get the feeling you are afraid of stents? you have already had an angiogram and the procedure is exactly the same with the exception that they put a stent into the blockage. For the sake of around 40-60 minutes, you could greatly improve your health. What has your cardiologist recommended?

[majedzak]

thanks ed34 for your reply, but is Medical treatment  (aspirin, a statin and a beta blocker) can manage my problems insted of stents?  

[ed34]

Well all heart disease increases risks of attacks/strokes. Your left anterior descending has an 80% blockage and further down is totally blocked. The total blockage is being bypassed by small vessels which are taking blood from a diagonal vessel which comes off the LAD. However, I don't know if the 80% is before any diagonal vessels, it doesn't say. It also doesn't say which diagonal branch is feeding the collaterals. At a guess, and it is a guess due to lack of detail, it would seem the left front area is fine for blood. The left circumflex has a 90% blockage in the OM2 and this will affect the rear/left bottom of the heart. They may want to stent this vessel. You are co-dominant, so both the left circumflex and the rca feed the pda. However, the pda is blocked by 90%. Due to the blockage of the PDA which is at the back of the heart, they may recommend stenting because it's more fiddly doing bypass surgery at the back of the heart. If they are happy with the LAD as is, then I can only see 2 stents required here, one for the PDA and one for the OM2.