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.

[nagrajjain]

Here one famous doctor Mandake who performed more than thousand bypass surgeries succesfully died of heart attack at the age below 50 years. After my first heart attack I was adviced angiography but I did not go for and I had second heart attack only after six years. I am sure from the status of my health that I will not have third heart attack at least for three years. In the name of not to take risk all much more risky methods are adopted. i am talking about my personal individual case.Medical profession should be made more and more accountable for their uncalled action and surgeries from commercial point of view. That is the only way truth will come out. Being noble profession nobdy question them is not desirable. Medical science is technology and not miracle.

[ed34]

If a Doctor guarantees 100% success, and something goes wrong, then he is liable. Not just by the patient if he/she survives, but to the family, relatives or friends also. We have to remember that medical professionals are only human and unforeseen circumstances can always present themselves. Obviously risk is seen differently by different experts, because at the end of the day it depends on their experience. A surgeon who has performed a particular type of operation 1000's of times would carry a much lower risk than one who has performed it just once. It was interesting when I had my LAD opened by the Cardiologist who was the first to use a balloon and Stent in the UK. The consent form stated 1% and he said "I'm not allowed to put zero, I have to put a higher number". All other Cardiologists I approached put the risk at 20% or more.

[kenkeith]

Q:"So, you have a decision. Do you a) stay as you are because you feel good enough on meds with a normal quality of life, or b) have the 70% lesion treated ?
If they said they could also open the LAD, giving two main feeds back to the left ventricle would you have this done also? so you don't rely on just one vessel?
I'm just wondering what your decision would be if this was your case."

....Obviously, I have had  over many years a reconfiguration and a normal adjustment of the blood supply to feed effectively heart cells over many years without any adverse medical circumstances.  If the LAD is opened, that will displace the reconfigured geography of the present blood flow system and whether there would be a favorable readjustment would be a risk that is unnecessary. Additionally my coronary system is right dominant meaning the rightside feeds blood into the left side that a left dominant configuration would would feed.

Q: "The cardiologist explains that if the LCX blocks, then there is an almost certain probability of death because the collaterals will also close, giving no blood to the left ventricle. "

.....I don't understand the logic.  If the LCX blocks, there can be cardiac failure and arrest whether there are collaterals or not!

Thanks for the comments.

[nagrajjain]

I am very happy with open discussions.What do you think probability is? It is guarantee only. No body expects 100 percent guarantee. Like probability guarantee too have percentages. Doctor should tell me that figure of probability. I will be happy with that too. I am engineer and not layman to be fooled by another expert.Thank you all for cooperation and openness. Nobody can be silenced by telling him he is fool.

[ed34]

" I have been doing well for the past 7 years"
That's good, but we can't base every case on this, and I'm sure you're not.
I do have a question though to put to you and wonder what your decision would be if in this scenario...
After an angiogram you are discovered to have a totally blocked LAD in the proximal section. Your LAD shows retrograde filling which means you have collateral feeds into the vessel. Further investigation reveals collaterals are being sourced from your LCX, but this now has a 70% lesion in the mid section. You have no symptoms with normal daily tasks while on medication, but on high exertion you suffer stable angina. The cardiologist explains that if the LCX blocks, then there is an almost certain probability of death because the collaterals will also close, giving no blood to the left ventricle. So, you have a decision. Do you a) stay as you are because you feel good enough on meds with a normal quality of life, or b) have the 70% lesion treated ?
If they said they could also open the LAD, giving two main feeds back to the left ventricle would you have this done also? so you don't rely on just one vessel?
I'm just wondering what your decision would be if this was your case.

[kenkeith]

Q: "Simply saying sense and non-sense is meaning-less. How ? You failed to explain.What I find here is that without taking risk doctor wants to grab my money. How far this is ethical.Why doctor can not guarantee the out come of his action when he is taking money".

...Statistical probability is not a guarantee. The doctor by his or her record of successful operational procedures can and should be considered competent to perform an operation but no guarantee of outcome.  No doctor can guarantee you would not have complications and pain, etc. from a bypass...statistically that is a reality.  So it doesn't make sense to risk the probability of complications, pain, etc. when the present quality of life is not impaired.

I know the extent of my CAD with a total calcium score over 1000 with totally blocked LAD and 72% blocked ICX.  I have been doing well for the past 7 years...not one day of illness, not even a head cold and I am in my late 70's.   It doesn't make sense to have an operation, and there would be no guarantee, nor would I expect a guarantee. I make the decision based on how I feel and the acknowledgement of the risks in consultation with the doctor if and when I would considering an operation...no guarantee expected just probability of risk v. benefit....presently all risk an no benefit...so it is nonsensical to even consider an operation and accoring to your posts your qualitiy of life can not be improved with an operation.