Cardiologists-I need an opinion on interpreting my CT and stress test

[Eagle1973]

I am a elite Ironman distance triathlete that just went through some heart testing: 1) holter monitor 2) echo of heart 3) nuclear stress test 4) CT 16 slice angiogram of the heart.

The results showed a inadequate amount of blood flow to the front of the heart during heart rates in the 180's on the stress test. Also, the CT Angiogram showed a 25% hard plaque of the LAD.

The doctor wants to do a diagnostic cath to see if soft plaque could bring any further blockage to the existing 25%. He also wants to stent if there is a 40-50% block because I am a athlete.  

Would you agree with this?  

[kenkeith]

AHA/AAC guidelines recommend a stent implant for occlusions greater than 70% and if there is angina (chest pain) that does not respond to medication.  An athlete shouldn't be an exception, in fact if anything an athlete should have further exclusiveness...better compensatory factors.

I recently had a CT cath angiograph 64-slice.  That is as good as a cath angiogram without intervention. It also includes the aorta ascending, arch and descending segments as well as the respiratory system.  The anatomy of vessels and calcium scoring of the soft plague (image of plaque between the inner linning and outer wall lining) and the quantitative scoring of each of the 5 vessels are analyzed and prognostications made for a heart event within a designated time. It is the rupture of this soft plague breaking through the endothyleum cells (lining) causing a clot and then an MI that is of intrerest.  

QUOTE "The doctor wants to do a diagnostic cath to see if soft plaque could bring any further blockage to the existing 25%. He also wants to stent if there is a 40-50% block because I am a athlete".

Large, calcified plaque is actually relatively stable and, because of its hard calcified covering, less commonly cracks (this is what the cath looks at!). The ct scan 64-slice (16-slice?!) angiograph views the more dynamic, less stable soft plaque that is much more likely to suddenly rupture. As the body forms a clot to try to heal such a rupture, the result may be a total blockage of blood flow; in other words, a heart attack. The soft plaque is hidden inside the walls of the artery and often causes no obvious blockage or loss of blood flow until, of course, the often-fatal rupture.

Your post as stated doesn't indicate a need for an interventional procedure, and unless your minor blockages cause chest pains uncorrected by medication, then maybe consideration for a cath.  I would get a second opinion before a cath, and when there is a cath an interventional cardiologist will almost always implant a stent...more money!  My current cardiologist is non-interventional.

[Encephalomalcia]

It is not good to have inadequate blood flow to your heart.  Your heart needs that blood to stay healthy and you do not want your heart muscle to be deprived of oxygen.  A cath would be good to find out exactly what kind of shape your heart is in.  No other test shows what a cath shows.  Sometimes doctors are surprised as to what they find from the cath.  If they do not stent if there is 50% blockage at that time, they will probably have to do a cath again and stent later when there is more blockage.  It would be safer to stent with less blockage to avoid artery tears etc.