whether cabg needed

[ajipc]

My father (74 years) had chest tightness feeling and sweating,no pain at all.we  checked his BP which was low and heart rate was low, we took him to the hospital ECG suggested inferior wall and posterior wall myocardial infarction.Troponin I WAS 0.91 MCG/L (POSITIVE)..They immediately took him to cath lab for angioplasty. Anigiogram showed following

LMCA---------:4.5 MM VESSEL NORMAL

LAD-------------TYPE3 (3mm CALCIFIED VESSELS) GIVE RISE TO 3 DIAGONALS AND MULTIPLE       SEPTALS.DIFFUSELY DISEASED WITH MAXIMUM STENOSIS OF 60-70%

LCX-------------NON DOMINANT(3mm VESSEL)GIVES RISE TO 4 MM.PROXIMAL LCX HAS MILD PLAQUING DISTAL LCX HAS 50-60% STENOSIS

RCA------------DOMINANT (3 mm CALCIFIED VESSEL) DIFFUSELY DISEASED FROM OSTIUM.PROXIMAL RCA HAS 70-80% STENOSIS.MID RCA HAS 90% STENOSIS WITH TIMI 3 FLOW DISTALLY

They said they found RCA has already opened up (by itself?) hence no angioplasty was done and cabg is the best option because it is a triple vessel disease.  I think they were also worried about passing a stent in RCA due to calcification.

as per the medical records they treated him with low molecular weight heparin antiplatelets statins nitrates.Thrombolysis WAS NOT DONE

dicharge medications were ecospirin,clopivas,storvas isordil and rabeprasol
(investigation in hospital revealed he had increased cholesterol level)

while our family friend who is a doctor saw angiogram cd said  LCX is not much problematic

my father is bit worried about cabg. we are in dilemma whether we can go alone with medical treatment( since rca is 90% occluded should  he need any intervention)
kindly advise us
A KUMAR

[ed34]

I think they meant they are assuming this was the culprit that caused the incident but the temporary blockage dispersed. Kind of like a bit of clotting material or plaque which broke up, releasing the 10% again.

[Occupant]

"They said they found RCA has already opened up (by itself?) hence no angioplasty was done".
If that happened, what did they tell you the blockage is now?

[ed34]

This is really a very difficult question because not all the facts are there. I don't see how a Cardiologist can make a decision about the best option for your Father without all the facts either. If this is my Father, I would suggest that they do a Nuclear scan to see how good the blood supply is on the right side. A nuclear scan will tell them if there are collateral vessels at work. If it turns out that there is a collateral vessel network on the right side, then again, if it is my Father, I would opt for good medication. Especially anticoagulation medication to prevent blood clotting in the vessel. If there is no collateral development, then I would then go for stenting rather than bypass. This is a problem in a single vessel, and to go for bypass just for one vessel seems over the top to me. All that risk and trauma just for one blockage doesn't make sense to me. If they feel they don't want to stent, ask them to refer you to a Cardiologist who has both the confidence and experience. If the Cardiologist argues, remind him that bypass surgery has no guarantees just like stenting. My bypass (triple) lasted for 3 months. I think you need to be very careful with your choices here. I am not a Doctor but I have been through a lot and seen many patients have problems. This decision will be very important and don't let them bully you into something you don't feel is right. Surgeons love to use knives, Good cardiologist love to use stents where possible. There is the risk of infection too with open heart surgery, whereas next to no risk with stenting.

[ajipc]

dear ed34
what they told was rca was blocked upto 90% now flow was occuring only through the remaining 10%. probably some block has occured to the 10% flow in the morning which led to inferior and posterior wall MI.and that got cleared by itself.they haven't told about any collaterals.so i am worried again will it(the 10% flow) get blocked.my fathers echo at discharge shows---NO RWMA.GOOD BIVENTRICULAR SYSTOLIC FUNCTION.please give me guidance about what to do next,CABG OR STENT FOR RCA OR MEDICAL TREATMENT
REGARDS
A KUMAR

[ed34]

So they are saying that the right coronary artery doesn't need anything because Collaterals have opened up to form a natural bypass? is that their report? If so, I fail to see why they would put a 74 year old through bypass when no other blockages are over 70%? Surely medication would be sufficient?