Doctors Please help and advise me in deciding my treatment options...

[sBuzdar]

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CORONARY ANGIOGRAM
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Catheter procedure:

Through right femoral artery. Seldinger 6F catheter passed to arota and LV. LV arotic pressures and LV angiogram recorded.

Left and right Coronary Angio done with judkins Coronary Catheter no 6F.

Angiocardiogram Report:

LCA      LMS:    Normail

LAD: Subtotal occlusion at mid course. Subcritical osteal disease in D1 and D2.

LCx: Moderate disease at mid course and in major OM.

RCA:          Dominant. 90% critical diffuse disease at mid course.

LV Angio:  Anteroapical severe hypokinesia. Impaired LV function.

Diagnosis:  TVCAD with impaired LV function.

Advised: PCI to RCA and LAD after viability scan.
                CABG surgery after viability scan.
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MYOCARDIAL SPECT PERFUSION STUDY
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Indication:

H/O MI in 2007- planned for CABAG/PCI toRCA and LAD. For viability and inducible ischemia

Stress:

Dipyridamole was infused coupled with low level excercise without any significant complaints and ischemia ECG changes. heart rate changed from 68 to 100/min and blood pressure from 130/80 to 140/90 mm of HG.

Findings:

Images acquired after stress injection of Tc-99m-MIBI showed markedly reduced to absent tracer uptake at apex,antoseptal wall,apical anterior segments and almost whole of the inferior wall. After resting injection there was no change appreciated in the defects noted during stress study.

Conclusion:

1) No evidence of any peri-infarct/residual stress induced ischemia.
2) Fixed perfusion defect at apex,antroseptal wall,apical anterior segments and almost whole of the inferior wall showing no sign of viability scan. All other segments are viable including mid and basal anterior wall,IVS and lateral wall.
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These are the angiography and viability scan reportf my father... We consulted one of famous suregeons here and he says that my father can not have CABAG nor angioplasty and should be kept on medicine. Angioplasty will not improve his condition significantly. However, angioplasty specialist say he shld go for angioplasty and will be having 3 stents... Please advise in the light of these reports as what should we do...Thanx in advance

[kenkeith]

CABG was not a very good option at the time I was admitted into ER 5 years ago for congested heart failure.  The heart's EF was 19-29%, left ventricle was enlarged, severe mitral valve regurgitation, fast heart rate, breathing problems, totally blocked LAD (collateral vessels provided a natural bypass), 72% blocked ICX, and RCA 98% blocked...RCA was stented to supply more blood to the area of hypokinesis.  I was in ICU for 3-4 days to stabilize and maintain the proper oxygen level within my system.  I had no warning prior to CHF.

I have always been of the proper weight, lipid levels were not an issue, regularily exercised, diet was as heart healthy as it should be so there was not a need to make any drastic changes.

Medication reduced the heart's workload and the enlarged left ventricle returned to normal size.  The EF currently is normal.  It was thought the mitral valve regurgitation was due to an enlarged LV and if and when the heart returned to normal the MVR would be normal...hasn't happened.

I work out 3 times a week, feel very well and not had an a single day of any health problems...not even a head cold.  I am active and there are no physical limitations...my only complaint would be short term "senior" memory problems, occasionally. :)

I smoked up to the age of 35 and abruptly quit, had tried several times prior without success by reducing the number of cigs and that never worked.  Smoking needs to be stopped as smoking compromises the oxygen input and requires the heart to work harder, and smoke can damage vessels were plaque will constrict vessel requiring the heart to pump harder, etc.  .

[sBuzdar]

Dear kenkeith,

Thank you for taking interent and giving your time...actually i want to know that how you decided that you will be taking only medicine and No CABAG or angioplasty?did you decided it urself or your doctors suggested it?also how long you have been on medicine?and what changes you made in your life style to live a healthy life again?do you drive at your own or with some body?......actually my father was smoking from the past 35 years and he quited it after his heart attack....thank you...waiting for your reply..

[kenkeith]

I agree with your surgeon.  Apparently, the surgeon believes the risk is greater than benefit.  Also, there is medical recognized study that shows there is no difference in longivity among CABG,. stent implants and medication treatment.  There are reports that many interventional cadiologists are doing unnecessary angioplasties and stent implants.

For more than 5 years I have a totally blocked LAD,  LCX is 72% occluded, and I am successfully treated with medication by a non-interventional cardiologist.  Once there is a stent implant, medication will not be effective and a stent can restenosis and sometimes there is a clot that can cause a heart attack.

If medication gives your father relief from any symptoms, then medicate.  If there is no relief from pain, etc. then a stent implant may be appropriate.