How much information is enough to agree to an angioplasty?

[JCC2009]

Some background before my questions --  47 year old female, one stent placement in 2004 because of chest pain and 90% blockage in main artery.  No issues, no pain, no problems since and now on aspirin only. --  Two non-related surgeries since 2004 with absolutely no issues heart or health wise post.  Blood pressure is 128/90 without medication, cholesterol is 258 without medication.  Last Thallium stress test was 2 years ago before hysterectomy; normal all the way.  On May 7 saw cardiologist to be cleared for other surgery and was sent for Thallium stress test and a sonogram.  I was fine during it, beginning BP was 128 something and right after the test it was 144 something and I am feeling wonderful, no chest pain, no symptoms, I sleep, I eat, I exercise, I have stress like everyone else - I feel great, actually!  on May 19 follow-up, Doctor said I needed to have angioplasty immediately and it could not wait, and said it was a blockage around the "same place as last time."   I only saw the picture results of this test which looked like a donut and I don't know the percentage of the blockage, I don't know of any scale, I don't know the results of any EKG and I don't know what the sonogram showed either.  The paper was thrust at me and after 6 mins with the doctor I still am standing here with my mouth open.  Honestly, I wouldn't have known what to ask until I began reading some of these forums!  So my questions are two.  1) Should I have the angioplasty immediately or can it wait?  I realize there is a blockage, but I have no symptoms and feel perfectly fine so in my mind it can wait.  2) how can it all be this bad that I have to have the angioplasty immediately when my BP is normal (even during exercise) and the cholesterol isn't as bad as it was in 2004 when it was 487+ something; and I have NO chest pain or anything!  Finally, I'm not going to risk my health, however I'm not ready to take on this surgery without more information, which I don't feel I am receiving to make an intelligent decision at this time.  Any help or information would be greatly appreciated.  Thanks!

[JCC2009]

Thank you, encephalomalcia!  I now have a grid to compare cholesterol levels!  I understand the blockage has to be dealt with, however the choice I DO have is that I will not be doing anything more with this doctor or the facility he is involved with.  I'll be requesting my file and changing doctors this week.  Once I have the file and another opinion with a cardiologist who does answer questions and give information I can find out if it is in/on/near the present stent or what is going on.  Thanks again!

[JCC2009]

Thank you Flycaster305!  Yes, shame shame on the doctor-maybe they're not used to people asking questions, but I need a little more and wasn't given the opportunity even after repeated questions.  I won't hesitate to have the procedure, naturally as I had one before when I was quite ill and knew something was off and it had to be done immediately, but this time nothing indicates to me its immediate as there are no symptoms and I would not be able to do what I have been doing if I were in the previous state of blockage.  As I mention to kendeith the doctor wasn't in any hurry to get me the results of such a deemed emergency after 13 days of waiting.  On the flip side I have to admit (struggling here!) that diet and exercise are not enough with this condition and Crestor will help to reduce the cholesterol.  All that pulled together I will have the procedure, but will be doing it with another doctor and another facility.  I'm going to call for the procedure report and a copy of my findings and will be getting a second opinion.  

Angioplasty is a good gold standard, and is basically easy, however the recovery should there be stent placement is a few weeks.  If I can push it back with this second opinion I will be in a better place employment-wise and matters at home, if I cannot then I'll have it right away.

I appreciate your information I have learned alot and the varying opinions force me to think.  Good luck to you as well and I'm glad to hear the CAD Monster is under control for you.  Stay tuned.

[JCC2009]

Thanks kenkeith!  Over the last few days I have indeed decided to get on board with another cardiologist.  Second opinion is a great idea.  I don't deny the blockage, however without additional information I cannot make a decision to have a surgical procedure the next day unless like the last time I had chest pain and knew something definitely was not right.  I understand sometimes there are no symptoms or very subtle symptoms, however I think this also presents itself that its time to change doctors.  Unfortunately without the opportunity to ask additional questions, my history with this doctor and the hospital/facility affiliated with the procedure and post-tests years ago feeds the case of change.  It would be better to feel confident and be informed before moving forward.  I guess I take the risk if I'm wrong, but I don't feel a few weeks will make a difference.  Besides, the doctor wasn't in any hurry to get me the results after 13 days of waiting, so that's two weeks of risk right there.  It also proves that diet and exercise are not enough (that was hard to say!), and Crestor helps a little to reduce the cholesterol.  I still don't know what Lopressor would do as its never been explained but my experience in taking it lead to 100 reading of blood pressure - way too low for me! - so I may hold on that one for awhile.  Thanks for your input; it helps!

[Flycaster305]

Shame on your Cadiologist for not explaining things better to you. I'm guessing that the nuclear scan showed an area of your heart that is starved for oxygen, indicating a block. Angioplasty these days is less invasive than a root canal, in my opinion, and I wouldn't hesitate to have the procedure.  Your total cholesterol count of 258 puts you in a very high risk group. When I was able to bring my total cholesterol down to about 230 from the high 300's, I felt I had it knocked, and after three heart attacks and eight stents I learned indeed I didn't, and lost weight, took meds, exercised, etc. and the aggressive CAD has stopped.

I'd request a procedure report from your doctor and research the findings.  From there, you might get another opinion, but the angioplasty is the gold standard for a diagnosis, and the risk is very minor.  

Best wishes, and do keep us informed.

[kenkeith]

If there wasn't the prospect surgery for an unrelated condition in the near future, I would say you could forgo angioplasty and/or get a second opinion from a non-interventional cardiologist.  Also, it should be a surgeon's call for any risk.

I have had a totally blocked LAD and a 72% occluded circumflex for more than 5 years since dx.  I do take a nitrate prior to my workout routine, and I have feel very well....you are asymptomatic!

[Encephalomalcia]

The main artery supports 3/4 of the heart.  If there is a massive heart attack in the main artery, the person will not survive. This is why the doctor is so convinced that you need to have surgery as soon as possible.  With women sometimes the only symptom is shortness of breath, sometimes only dizziness, and sometimes no symptoms at all.  If the blockage is there, it needs to be dealt with.  If there is a stent now there and the stent did not take care of the blockage, then surgery would be needed.  In the future, know your cholesterol levels.  LDL should be 100 or below, HDL should be 50 or above, triglycerides should be below 150.  Blood pressure should be 120/72 or below.  Know how much inflammation is in your body.  When a person has inflammation, that inflammation gives the cholesterol a place to stick.  Talk to your loved ones and think this over.  I do not know of any other choice that you have.  Take care.