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."

[ed34]

Interesting, but LVEF doesn't necessarily reflect Ischaemia occurring. It would really depend on the amount of heart tissue being affected. In my case, just the bottom of the LV is low on blood and my EF is 70% which it always has been.
The best test to show blood supply to the heart tissue is a nuclear perfusion test. This comprises of 2 scans, one with the heart stressed and one with it at rest. It gives a good idea to the cardiologist if collaterals have formed and which vessels are likely to be giving problems. In some cases a stress echocardiogram can reveal a weaker function in certain areas of the heart due to Ischaemia, but most are inconclusive and the patient ends up having a nuclear scan.

[nagrajjain]

Thank you both of you. Blockages result in reduced blood supply to heart muscles. This may result in ischemia of heart muscles. Due to this heart can not pump as efficiently as before. LVEF get reduced. This is the link.
My question about test to find out extent of ischemia remains unanswered.Thank you once again.

[ed34]

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

[kenkeith]

I believe your questions were answered in another post? May be it was another member's question. Anyway to determine the degree of soft calcium plaque (calcium between layer of the vessel) can be determined with ct scan 64 or greater slices.  Soft plaque accounts for the highest percentage of heart attacks when the plaque ruptures through a crack in the lining.  Hard plaque can dislodge and cause a heart attack as well.

A bypass is appropriate when there vessel stenosis (partial blockage usually hard plaque seen with cath angio).

I had a heart attack about 6 years ago, and my EF was below 29% and an enlarged heart.  With medication a stent, my heart is currently a normal size and the EF is 59%.  

Ejection fraction is the amount in a percentage of the blood pumped with each heartbeat.  Normal is 50 to 70%.  When there is a decrease in the EF it is usually due to heart muscle damage that impairs contractility due to having had a heart attack.

I haven't been following all of your posts, and ed is certainly capable of giving you helpful information.  Take care.

[nagrajjain]

What you said is right. If bypass is the solution for valnerable plaque? I do not think so.Please tell me the proper test to confirm the extent of ischemia to heart. According to me my physical capacity is the best indicator which takes into account colateral blood circulation too. However LVEF is the second best indicator. Please tell me in detail because that is going to enable me to go for bypass or not. I wonder extent of blockage shown by angiography and my LVEF which is 50% do not agree.Why doctor do not think about that. Thank you once again. Please tell me for sure. Or should I think of CPK or CPK-MB?

[ed34]

A few years of stress and high blood pressure as a result would be enough to start the process of atherosclerosis. Your heart attacks would have been caused by a clot or rupture of existing disease. As disease progresses, most people experience symptoms which enable the blockage to be diagnosed before 100%. Now that Doctors are making a more accurate diagnosis regarding cardiac problems, deaths from heart attacks are reducing in the UK.