Coronary heart disease 50% blockage in LAD and RCA with severe angina symptoms. HELP please!

[soleole]

Hello,
After a recent angiography my Dad was diagnosed with Coronary heart disease with double vessel obstruction. They found 50% occlusions in his Distal RCA and Prox LAD as well as an in-stent restenosis from a heart attack he had 4 years ago. His condition has been worsening for about a year, and in the recent months it has deteriorated considerably, he now has symptoms of angina on a daily basis, chest tightness, breathlessness, fatigue, headaches, swollen jugular, he has to sleep sitting up due to lack of breath, cannot walk for more than 5 minutes, etc. The meds are not controlling this very well and the doctors seem to pay no attention because 50% is not 'that bad'. What can be done?? if the combined occlusions are not 'that bad' why is he having such strong symptoms? his life is severely impaired at this point and we don't know what to do, could anyone please offer some advise? thank you!

[ed34]

I get sick and tired of hearing this baloney about 50% being ok and 70% not. Even a 30% blockage can give some pretty nasty angina discomfort. 70% and above is simply seen as a 'risk' and nothing to do with symptoms. In a study using FFR which is a tiny sensor on the tip of the catheter, flow rate/pressure changes were measured across blockages. It was seen almost instantly that the idea "the bigger the blockage the more symptoms" is absolute nonsense. In one case, the cardiologist said he had a patient with a 30% blockage and an 80%. In normal cases he would have left the 30, and stented the 80. However, the FFR showed this decision to be incorrect, the 30% was giving far more resistance while the 80% was giving hardly any at all. The cardiologist stented the 30 and the patient felt fine afterwards, whereas, if the 80% was stented, angina would still have been present.
The way pressure and flow rate is controlled through the coronary arteries is quite complex and not simply a judgement on the blockage size. I would ask your cardiologist what the pressure/flow drop was across each of the blockages. If he says he doesn't know, I would ask 'why not because you have the equipment for it'. I would get tough with your cardiologist and if necessary ask him to read a few research papers or go on some refresher courses. Go get him.

[jrbon]

As Dr. said 50% are not too bad but, what about the restenosis of stent? Where and how big is it?

In the other hand some of the symptoms that you indicates are related to Heart Failure, what do you know about the situation of that? (Ejection fraction, Hearth enlargement, BNP levels ...) And possible other classical complications of HF (anemia, pulmonary edema, renal failure, diabetes..)

So probably all those indicators made the drs. don´t pay too much attention to the blockade because they are more worried about something else.

So what the drs say about what their symptoms are due to? What drs. say about possible evolution? If you do not get the right answers look for a HF specialist and get a second opinion.

Jesus.