Heart

[Prit12]

Hi ! I am Priti Vyas,

My father aged 70 years had a subtle pain last May 08 which he couldn't describe and which subside in few seconds by the time he was admitted in the Hospital. On admission his ECG was normal . It was just one day stay in the Hospital. His Echo Cardiogram then was normal and showed apical hpokinesia overall LVEF was 56%. Conclusion- Ischaemic Heart disease with preserved LV Function.

Just a week back we got his CT Coronary Angio done. Results were as follows :
Calcium Score was  522.7
Extensive calcific plaques seen in proximal LAD with soft plaques and narrowing of lumen. The distal LAD showed no abnormality.
Diffuse plaques in mid RCA moderate narrowing of its lumen.
No anomalous coronary artery noted
ostium of both coronary artery normal.
posterior descending artery normal
Left Main artery normal
D1-D2 normal
Conclusion - Calcific and soft plaques seen in the proximal and mid LAD causing narrowing of LUMEN. Diffuse Soft plaques seen in mid RCA causing moderate narrowing of its LUMEN.Catheter Coronary Angiogram Recommended. No other significant abnormality

Now my father is adamant for not having catheter coronary angiogram done. Would 2D Echo - cardiogram with doppler help. He takes walk and has medicines prescribed by cardiac regularly alongwith ayurvedic medicines.


PLEASE HELP!

Thanking you,
Regards,

Priti Vyas

[kenkeith]

Unfortunately, I made an error in first post...I do know the difference between angioplasty and an angiogram.  I tried to make a corrrection in my second post and inartfully referred specifically to just an angiogram (cath vs. CT scan).  Prit's father had had a CT angiogram and now the doctor wanted to do a cath angiogram.  I meant to say and said the cath angiogram was unnecessary unless it was agreed and understood that there would in all probablity be angioplasty (stent, balloon) with a cath angiogram. there is a higher than expected  probability there would be a stent implanted with a cath angiogram ...there are statistics available).

You may not be aware that both a cath or CT scan angiogram 64 slice are procedures that inject dye to view perfusion, and determine if and where there are any lesions in the lumen of the vessel as stated in my previous post, and the CT scan is much more inclusive and almost as good as cath to evaluate lesions in the lumen. So to do a cath angiogram subsequent to a CT scan angiogram doesn't make medical sense unless there is going to be angioplasty.

I encourage you to google COURAGE study if you believe an angioplasty is superior treatment to medication.  Five years ago, my former cardio doc wanted to stent my circumflex (72% blockage and no symptoms) after stenting the RCA several weeks prior.  When asked why the circumflex was not stented at the time of the RCA?...he went into the mode of not understanding English very well.  I also asked what a stent implant would do for me? He shrugged and walked away...he moved out of state a few weeks later.

[pat608]

At the risk of sounding like a "know-it-all" I just have to correct one thing that KenKeith said about angioplasty (sorry KenKeith : ).  Angioplasty would mean he had surgery to repair the vessel.  Plasty means repair. The cath would determine how much occlusion is present, where to occlusion is, etc. It is also beneficial in hepling to assess any inflammation as well as plaque build up. During the cardiac cath, they would inject dye and be able to see the path that the dye travels.  This would help them see any potential problems and whether angioplasty is warrented or if medication and observation is a better option.  I would encourage him to have the cardiac cath done. He should follow his doctor's advice.

[kenkeith]

Correction, meant to say:... The CT scan is angioplasty ( an "angiogram") and a cath angioplasty is unnecessary unless there is going to be (an agreed stent implant) as a cath would only verify what the CT images show.  The CT scan is more inclusive than a cath as it views the anatomy of the vessel, respiratory, aorta, etc. as well as the lumen...the cath only views the lumen unless there is ultra sound attached to the probe.
(Your father's ischemic condition is not as advanced as my condition, and I have been on medication for the past 5 years without any problems.)

[kenkeith]

The CT scan is angioplasty and a cath angioplasty is unnecessary unless there is going to be a stent implant as a cath would only verify what the CT images show.  The CT scan is more inclusive than a cath as it views the anatomy of the vessel, respiratory, aorta, etc. as well as the lumen...the cath only views the lumen unless there is ultra sound attached to the probe.  

An echocardiogram would not show any ischemia...echo establishes dimensions of the heart walls and chambers, blood flow, and wall movement impairment if any.  The prior echo showed some wall movement impairment ( if serious EF would lower tnan normal...normal is 55 to 75% and indicates the percentage of blood pumped with each heartbeat).

Whether to go ahead with a cath depends on whether there is angina (chest pain, or other symptoms related to ischemia and not controlled with medication).  Medication, stent implants, and a bypass treats the symptoms and does not prolong life or any differential benefits.  A study on the subject is the COURAGE study.

[Encephalomalcia]

What is his blood pressure currently?  Does he take a good cholesterol medication such as Lipitor?  Cholesterol medication can reduce calcium already in the heart in higher doses.  Medication is always best if the heart situation is not life threatening.  An angiogram at the age of 70, can have more risks than for someone who is younger.  Sometimes the arteries become thin or weak, which increases the risk of an artery tearing during an angiogram.  Does he have diabetes?  If so, this would increase his risk.  His LVEF is great!  Left main artery is normal, which is the most important artery.  Ask his doctor why they are recommending an angiogram and what they are looking for and intending to do.