Coronary CT Angiogram

[Irshad51]

From Irshad Khan, New Delhi, India

I have taken last week CT Angiogram and its findings are worrisome. The main impressions are:

Calcium score:      18, Soft plaques seen in proximal LAD and D1 segment.

LEFT CORONARY ARTERY

LM   -  Normal

LAD   -  (Prox/Middle/Distal)-  Type -III LAD with normal course. Focal Eccentric non-calcified plaque seen with moderate luminal narrowing.

Diagonals----  
D1    -----   Single large D1 branch seen with normal course. Mid vessel reveal plaquing with moderate luminal narowing.

Obtuse Marginal Branches

OM1   --- Normal
OM 2  ---  Large OM2 artery seen with distal branching. Proximal vessel reveal focal luminal narrowing with approx  60-65 % stenosis.

Please advise me what course of treatment is advisable.

[kenkeith]

Q:" I'm not quite sure what you are saying here? Are you saying that for every stent implant there is a 'new' risk that a lesion will form elsewhere, because of that stent?"

>>>>.Yes, based on fluid dynamics.  For instance, when a there is a stent implant the coronary wall is propped open and the other sections of the vessel normally continues to dilate and constrict when stimulated,..This wil cause turbulence when a portion that has a stent implant has a wider fixed diameter than the lumen prior and subsequent to the stent portion and is directly proportional to the length of the implant and/or end to end implants.  

Also as a result of blood flow that will change the blood flow and pressure to distal and prior portions of the stent implant and its contributory beds and vessels of the stented implant, etc. This will effect other segments in terms of blood flow velocity and pressure.  Vulnerable segments can be adversely effected in an attempt to establish equilibrium of blood flow to all parts of heart tissues. etc. This can happen as a stent will shut down the collateral vessel's contribution to other segments that may not be directly related to the subject vessel's feed.  A collateral vessel is not necessarily a direct bypass of a lesion but it can feed into another vessel that will feed the deficit portion of the heart to maintain the integrity of the system. Another stent will disrupt that blood flow!, etc.

To have many stents is to abnormally redistribute blood flow and may/will cause undue pressure to other vulnerable sections of the vessel configuration and in time another stent is required, etc.    

[ed34]

I'm not quite sure what you are saying here? Are you saying that for every stent implant there is a 'new' risk that a lesion will form elsewhere, because of that stent?

[kenkeith]

Q: "I think it's important to also add. Never have new blockages formed around previous intervention. They have always occurred at a new site".

Doctors should be accountable and consider the effect of a stent implant on the coronary vessel system as it relates to the logical elements (blood flow, pressure, and resistence) of the other segments of the cardivascular system.  For every action there has to be a reaction on the logistical characteristics of hemodynamics... there is no way other segments are not effected, and it can't be without some change to maintain a healthy or unhealthy equilibrium of blood flow .With that in mind someone who has had a multitude of stent implants increases the probability and appreciate(fully aware) the negative effect on the native vessels and a new site vulnerable for an occlusion.    

[Irshad51]

I saw a prominent invasive cardiologist today to discuss my case based on CT angio and seek his opinion. After reading the report he suggested cath angio. CT angio percentage narrowing does not give adequate indication.  On asking he told that there was no emergency as there are no  symptoms. According to him there are two approaches:
1. Go for cath angio for diagnostic purpose and if something is required in  any artery could be done. If all is OK, a person feels reassuered.
2. Do not go for angio, but there may be anxiety if any chest discomfort or pain happens.      

He has suggested Thallium test to find out flow of blood in coronary arteries. I have decided to go for it as it is a non-invasive procedure and would further give an idea of coronary artery narrowing.

He has prescribes-ecospirin 75 mg OD, Resuvastatin 20 mg OD, Concore 5mg.  Resuv is more potent than lipitor (atorvastatin) keeping in view my long history of high cholesterol and triglyceride. Concore would take care of angina. This prescription is preventive according to him.

I am happy that there is no need for an immedeate cath angio. I will report to the group the results of Thallium test and another consultation with a non-invasive cardio.

[ed34]

I think it's important to also add. Never have new blockages formed around previous intervention. They have always occurred at a new site.

[ed34]

"I am sure from the status of my health that I will not have third heart attack at least for three years"

I wish I knew my body that well. I felt great and then three months later had an attack.