Concerned about my heart health.

[agapeman]

This is my first post and I'm here because of recently discovered heart issues. My doctor recommended I have a heart scan for calcium, (plaque in the heart arteries) and when that came back my score was 957 which I understand is extremely high, and they found six areas of concern. The biggest concentration was in the left artery and in the LAD. My doctor got me on a statin and I made radical changes to my diet immediately. I had a nuclear stress test 2 weeks ago and they stopped it before I was finished due to abnormalities in my ekg. The tech showed me the scans and said it was clear I had restrictions and one definite blockage going on on the left artery. Of course i am concerned, my doctor told me to quit jogging for the now and referred me to a cardiologist I will meet with next Thursday to get started and schedule most likely a angiogram. I'm a bit flipped out about all this and a lot of people count on me due to my profession which makes it hard for me to talk to anyone. My wife is great but she can't handle the details I'm trying to figure out and I don't want to overly concern her so I've come here for some support. I'm big on research and I may be getting ahead of things but the main question I have is how does a cardiologist determine if angioplasty and stents will do the job during the angiogram rather than pulling out and considering bypass instead? The Dr. said he will consult with me during the angiogram but should I have to make a call on that while I'm in the procedure? I'm aware of the debate between stents and bypass surgery and I want to fully consider my options if necessary. I've never had any health issues in my life before and am in shape and the waiting game and uncertainty about all this is weighing on me. Thanks for any input.

[Flycaster305]

If you have Calcium in your arteries, you certainly have more than that in most situations.  I don't think cleaning out the arteries is an option, or even possible.  

I've had both bypass surgeries and I think ten stents.  The bypass surgery was done as I had to blockages in areas very difficult to insert stents.  All my stents have remained open, but my bypass failed about two years after surgery, they plugged with plaque and blood clots, so using a new stenting technique my native arteries were opened.  I'm relating this to you so you can understand there aren't easy answers, especially by us laypeople!  

If the blockages are in a difficult position, e.g. the 'ostial' position (where the diagonal arteries branch off, bypass is I think the usual option.  Your interventionalist would determine the best way to go.  You will be awake and able to think somewhat clearly, but you won't remember conversations!  Also, generally blockages in the LAD are the most dangerous, they referred to as 'widow-makers'.  

A third but uncertain option is trying to develop collateral arteries, which are tiny vessels that sometimes enlarge enough to serve as major vessels.  However, that involves a lot of drugs, exercise and a lot of finger-crossing.  I can't develop them.

I would certainly educate yourself, but when it comes down to a decision what to do, I'd hire the best and most experienced cardiologist and trust his/her judgement.

[Occupant]

Trust me, the old pipes are still better than the new ones - the replacement is not new anyway and yours arteries are hardly lived in. But it may be a moot point, if they determine that there is too much Calcium Phosphate in the artery they will do a bypass anyway unless you find a surgeon who will ream them out - as long as we are talking about pipes.

[agapeman]

Thanks for your reply.  I understand what you are saying and I know it is oversimplification on my part but if given a choice between new pipes and fixing up the old ones in a house it almost seems to be worth the effort and cost to replace the pipes.  That is how I look at it, and again I know very little.  I just want to make sure before I get the Angiogram that the cardiologist isn't going to try to just fix the old pipes if a new set is needed. I'm not getting how that process works in the medical community.   Am I wrong to assume a cardiologist is going to prefer to stent me up during the angiogram?  Does the cardiologist and surgeon collaborate on a decision?
    

[Occupant]

I agree you should have an Angiogram done, however, my concern was and still is - and may be, it should be yours too - that my Agaston Score iwas 1243 with my LAD alone at 783. That, obviously, indicates a lot of Calcium in my LAD. During an Angiogram they like to stent right away and that would be generally the right thing to do, but what about all that Calcium? That should be removed first before they stent otherwise they might damage the artery.