CABG

[nagrajjain]

"After six years I have second heart attack.IWMI.Angiography shows all three major vessle blocks to the extent of 90% at near end and 70% block at far end.Physical capacity of body is normal. No pain even during exercise. May be due to colateral circulation. Advised CABG. Fearing problems after surgery not feeling to do that.Please advise."

[nagrajjain]

My LV dimentions are normal after 2D-echo. No hyper trophy. IWMA-inferior wall motion abnormality is observed. Inspite LVEF is 50% then why go for bypass? MY heart beets 60 bm. My blood pressure 175/105.According to me you have fully understood me.Thank you for your contribution. Your answer is the best answer. I will verify with second openion to to find out the best solution.

[kenkeith]

I agree with ed that the location of the damaged heart cells will have an effect on the cardiac output (stroke times heart rate)..

QUOTE: "And if blood supply through coronary artery to LV is affected quantity of blood pumped will be affected. Therefore coronary blockages and LVEF are linked. Provided other factors are normal".

>>>>>Cardiac output involves compensating system components that include heart rate, ejection fraction (not static....will normally dilate to increase contractility), vascular constriction and dilation, etc.to maintain a balance of blood flow between right and left side of the heart.  If the normal condition is compromised and not properly treated, the LV will continue to dilate (over compensate) to the degree that is abnormal and that will cause a drop in LVEF (Frank-Starling mechanism).  

You are correct, if coronary vessel blockage is severe, the normal compensating components will be ineffective and the result will be an enlarged left ventricle and a drop in the LVEF. If  there is blockage that is not significant the LVEF will likely be in the low normal range or possibly lower!  Referring of course to an ischemic heart condition.  

[ed34]

"If heart muscles are damaged herat's capacity to pump blood will be reduced"

It depends on how much heart tissue is affected. Like I said, just the bottom of my LV is restricted and I have 70% LVEF.

[nagrajjain]

First and formost requirement is my body should get adequate quantity of blood. This means heart should pump out that much blood to body. If heart muscles are damaged herat's capacity to pump blood will be reduced. Heart muscles will be damaged if coronary arteries supplying blood to heart are narrowed or blocked. In this process LV plays important part. And if blood supply through coronary artery to LV is affected quantity of blood pumped will be affected. Therefore coronary blockages and LVEF are linked. Provided other factors are normal.
Thank you for giving me opportunity to explain.

[kenkeith]

QUOTE: "Why do you feel there's a link between your LVEF and your blockages?"

In my situation, the blockage and lack of oxygen caused hypokinesis (heart wall movement disorder) that weakened heart wall contractions and lowered the EF to below 29% (heart failure range). The good news is/was the heart cells were hibernating (google for more info) and the heart cells were revitalized with an increase of blood flow with a stent and medication.  After several months an echo indicated hypokinesis was minimal and my heart size and EF were now normal. Take care.

[nagrajjain]

Thank MedHelp and all who answered the questions. My own decesion is not to go for bypass and manage with medicine.On 21st I will be seeking second openion with cardiologist. I have faith in him that he is not interested only in money. In my first heart attack also I had consulted him. I will let you know about that.
Answers both by ed34 and kenkeith were in agreement with my openion. When we three agree there is little left to be decided. Till then thank all of you.