Coronary artery disease plus aortic stenosis

[save]

I have been treated for CAD since 2000.  At that time the I was told that the Left Anterior Descending artery was 40-50% blocked and a branch off of it was 70-80% blocked.  It could not be stented because it would jeopardize the LAD artery.    I went back every year for a stress echo test and 2003 he started suggesting possible surgery because of symptoms- said he could see my heart.  In 05 symptoms got worse and went to another Dr. for second opinion - he did stress echo test, echocardiogram, cath which showed 60% CAD, not sure what branch showed other that he told me he could not stent what he wanted to stent. I was told surgery because of symptoms - bipass grafts to LAD, two LAD diagonals and the RCA. I was told that I will need aortic valve surgery in 1-3 years (aortic stenosis)  Now he has changed his mind and wants to stent 3 of the coronary arteries which he said may help symptoms.  Said that I will need surgery at some point.  I am taking stronger medicine - Toprol XL, Nitro Patch increased to 0.4, Liptor 20mg  Symptoms have increased this year and changed. Use to do 4.0 on treadmill ( typical symptoms were pressure and some jaw) Jan.05 started  getting an aching/ pain/pressure plus the jaw would radiate and get intense, plus sometimes the left arm. Short of breathe at times.  I can't go above 3.4-3.5 and  symptoms start soon. I take nitro at times now on the treadmill plus I have the patch on. SometimesI get angina when I am not doing much.  I need to know  what symptoms I need to address. I probably would not seek emergency help, because I am confused. I am 66.

[save]

Thank you for you answer.  It always helps to have opinions.  Nothing has changed about my health.  I do not have anything else wrong with me for him to change his mind.  I went to him because I had started getting more severe symptoms and was not able to exercise like I did before plus had angina not exercising at times.  He put me on different doses of medicines and told me to let him know if I got severe symptoms.  I  let him know about symptoms and he suggested to let him set up surgery.  This was a surprise to me and I told him that I did not want to do surgery.  He had me make an appt. and talked about stenting the 3 coromary arteries that he could stent.  He said that these 3 were not the ones that would cause the heart attack but might helped with the angina.  He said that he could not promise anything.  He said that he had changed his mind about surgery at this time.  Said that when they had to do the valve they would do all the coronary arteries.  He said that he did not have a crystal ball, which I understand that.  I have seen 2 cardiologist - one does not me to have symptoms and         I am not sure exactly what the second one thinks.  I think that he thinks that I have to use my common sense about symotoms.  I think that the blockages that I have  I will always have symptoms especially exercising, but I got concerned when they changed a lot.  I realize that no one can predict a heart attack.

[EchoTech]

I would get  a second opinion from a major center somewhere else.  Most doctors don't change their mind from surgery to stents unless there is something else that has developed that would be more probable for injury to you to undergo surgery.  It is easy to play armchair cardiologist, but something has changed along the way for him or for you to go with the stents.

[Cleveland Clinic]

save,

thanks for the post.

You should seek attention for any symptoms which seem different, more frequent or more severe then what you've had over the last 5 years.

There is no right answer on surgery vs. angioplasty and stenting and a lot would depend on your anatomy and the comfort of the person doing either procedure. One thing that might help would be to get a second opinion from another cardiologist.

good luck