How to treat Diffuse Triple Vessel Disease ?

[Padmavathi1967]

My Father has Diffuse Triple Vessel Disease.
He is 72 and non-diabetic.
He doesn't have any symptoms and he is very normal.
He had a mild chest pain when walking so the doctor adviced to take angiograph after TMT.

Angiograph Report :

Left Main - Normal

Left Anterior descending Artery -
type 3.Proximal LAD is calcified.Mid LAD has two tandem lesion of 80% & 90% respectively.Distal LAD has 80 to 90  % long segment lesion.

Diagonals -  
D1 is a large sizedvessel.
It has multiple 80-90% lesions.


Left Circumflex Artery -
Non-dominant - Proximal LCX is calcified .
Mid LCX has 90% stenosis.Distal LCX has 90% Stenosis.



Obtuse Marginal Branches -
OM1 is a large sized vessel.
Its lower division has 80% stenosis.
OM2 is a large sized vessel .It has 80%ostiproximal lesion,.
OM3 and OM4 are moderate sized normal vessels.

Right Coronary Artery -
Dominant  - Proximal segment has 90% stenosis.Mid segment is totally cut off.
Remaining  RCA,PDA & PLV are visualized thro, ipsilateral collaterals from proximal RCA.

FINAL IMPRESSION -  Diffuse Triple Vessel Disease

Advise -Early CABG.

This was the Report.

Medicine Prescribed by the doctor :

Atrovastatin Tablets IP 20 mg - CAAT 20
Nitrolong 2.6 -Nitroglycerin controlled Release Tablets 2.6 mg
Happi-it     -      Rabeprazole 290mg EC & Itopride 150mg SR Capsules
Clopilet A 75   -   Clopidogrel and Aspirin Capsules
Esamilo - 2.5     -      S(-) Amldipine Tablets IP
Ativan 1mg     -  Lorazepam Tablets B.P

After taking th medicines,the pain has been subsided and is very normal now.

I seek for a suggestion from you for his condition.

Thank you,
Padmavathi

[Sanju2907]

Please advise for my mother. She is 68 years old, short 147 cm height and heavy 77 kg. She has history of diabetes of 20 years with insulin from past 15 years. Single kidney for 12 years. Before angiography Creatinine value was 1.2. But generally her creatinine value remain below 1. Due to some Ayurveda medicines, it reached 1.2 recently.

She recently started feeling palpitation between lower chest and feel short breathlessness after 500mtr walk. We did Angiography.

Please suggest is there anything Serious?    

INDICATION : Stable Angina, DM, HTN

LMCA : Normal

LAD : Type III Vessel and Proximal 50-60% stenosis
Mid Segment has long diffuse disease with Maximum 70% stenosis. Distal Mild Plaquing

DIAGONALS : D1 diffuse Plaquing (Small Vessel). S- Mild Plaquing

LCX : Non Dominant vessel and mid segment 50% stenosis
Mid LCX subtotal occlusion with TIMI I flow

OMS : OM1 Diffusely diseased (Small Calibre)
OM2, OM3 – small vessel. OM4 Proximal 80% Stenosis

RAMUS : Mid Mild Plaquing, Distal 70% Stenosis

RCA : Dominant vessel and Proximal 60% stenosis
Mid 70% stenosis. Distal RCA has 90% stenosis
RV branch has tandem Lesion 80% each. PDA – Ostal occluded with Retrograde fill from LAD. PLV – Normal

IMPRESSION : Triple Vessel Disease

Advice : CABG

[sai1237]

hello , my father is 53 years old and had an attack for the secondtime, as per reports below is the info :

LAD :type III vessel & ostial 99% stenosis
MID 90% Stenosis Distal Diffuse Disease

Diagnols : 1 in number and normal

LCX : Non-dominant & Proximal 90% stenosis

OM: 2 in number & diffuse disease

RCA : Dominant & Proximal 30-40% stenosis ad MID 60% Stenosis  

As doctors are telling his vessels are completely damaged and nothing can be done and bypass also cannot be done . Please suggest something can be done for this case. Doctors are telling they can do stunt on the right side and tht will help 20-30%  pls help for this case if something can be done.

[sps98]

angiogram tells
    LEFT MAIN: normal divide into LAD/LCX
     LAD:    TYPE III,proximal 95%,mid 90% stenosis.
      D1 : small vessel 100% CTC
       D2:Normal
     OM 1  ostial 90% ,large vessel.
     OM 2 : normal
     OM 3 : normal
     RCA :dominant 40% stenosis
      PDA :proximal 70-80% stenosis
      PLV: Ostial 90% stenosis
      
        TVD
recommendation :multivessel PTCA /CABG
  AGE 67 years
ONE YEAR OLD SUGAR (controlled)
Angina resolved with medicines.
Breathlessness on walking is still the problem
  please advise

[ed34]

you have unstable angina? are you certain it doesnt present itself during exertion or after eating?

[woodydebroah]

55 year female, hypertension, unstable angina, anterior q waves. high coronary artery plaque burden extensive calcified plaque dominant RCA. LAD mod calibre with low volume shallow non calcified plaque proximal segment no stenosis, under-filling of distal portion.
Circumflex system:OM2 multi focal calcified plaque within proximal segment mild lumen irregularity. Large branching OM1 with ostial calcified plaque.
RCA dominant, moderately extensive, predominantly calcified plaque in proximal & mid segment without stenosis, early rising diminutive PDA on CT CA awaiting echo advise on possible treatment and prognosis

[bassam33]

Helo
My father is 61 years old . and from 4 weeks ago he got heart attack and water in lounge , we went to hospital and  he stayed one week in the care room for decrease this water which in lounge as the breathing was very weak . anyhow the doctor advised us that we should be make Heart Operation urgently and we are very afraid from that because his muscle heart is very week is 31% and he has also diabetes and his weight is 60kilo .
This is the report which we got it from the doctor , please advise us me what we can do or it should be make to him Operation or not ?  
Procedure:
The patient was prepared & draped in the usual manner.
The right groin was infiltrated using 10 CC  Lidocaine 2%.
Procedure re was done through Rt.femoral artery puncture.
A 6F sheath was inserted.
• Preshaped  JL4    & JR4   catheters  were   used   for   selective coronaryangiography, which  was  done  in  multiple views  & obliquities.
Angiographic data :
Left Main Artery:
Atherosclerotic  diseased  artery   bifurcating into  LAD   & LCX   and shows 50% stenosis at its distal segment.
Left Anterior descending Artery:
Atherosclerotic diseased vessel  gives  many  septal and  diagonal branches andshow  70%  stenosis in its proximal segment followed by total occlusion at theproximal to mid segment.
Circumflex Artery:
Dominant Atherosclerotic Diseased and shows proximal 40% lesion.
Right Coronary Artery
Atherosclerotic vessel, shows multiple lesions at its proximal segment followedby
raid segment total occlusion with retrograde filling  from Lt System.
Final Diagnosis and Recommendations:
Multi –vessel  CAD for CABG.

[MoNaeiji]

the below is my 66 years old father coronary angiography report, I need help and advise for what procedure we have to take

Under Local Anesthesia
Approach: Femoral
Dominant System: left
E. F: 45%
L.V Wall motion: Global hypokinesia
LV: 140/0-18
Aorta: 140/80
Left Main Stem: Normal
LAD: proximal has multiple stenosis up to 70%, at bifurcation with the diagonal is near cut off with delay run off and multiple stenosis at mid portion and also good distal run off
Septal: Ostial of the septal has stenosis up to 90%, a large vessel
Diagonal: Ostial has stenosis up to 80% , a large vessel
LCX: Ostial has a mild stenosis with good run off, a large vessel
OMs: Ostial has stenosis up to 60%, small vessel
RCA: Has Multiple stenosis from the origin up to the mid about 95% with no good distal run off

kind regards
Mosez

[RSENGUPTA]

My brother 46 years old with
LVEF 60  
LMCA DIFUSE 50 DISTAL 60
LAD DIFUSE WITH PROXIMAL 40 PLAUGE
DIAGONALS PLAUGE
LCX DISTAL 90 LESION
OM OM1OSTIAL 90 SMALL SIZE VESSEL
RCA PROXIMAL RCA 95 UNCERATED PLAUGE MID RCA 80

PLEASE HELP CAN THIS BE TREATED NATURALLY?He has been advised urgent bypass

[manu4445]

LAD: type 3,Proximal,mid and distal LAD diffusely diseased with 90% stenosis
Diagonals:D1 and D2 has ostial 80% stenosis
Intermediat:NIL
LCX : Proximal LCx has tubular 60% stenosis.Distal LCx has luminal irregularities to a maximum of 40%
Marginals: OM1 and OM2 has diffuse disease to a maximum of 90%
RCA:RCA has ostial 80% stenosis
PDA/PLV: PDA has a tubular 70% stenosis
LV: not done
creatinine:1.8


what is the solution ?

[manu4445]

LAD: type 3,Proximal,mid and distal LAD diffusely diseased with 90% stenosis
Diagonals:D1 and D2 has ostial 80% stenosis
Intermediat:NIL
LCX : Proximal LCx has tubular 60% stenosis.Distal LCx has luminal irregularities to a maximum of 40%
Marginals: OM1 and OM2 has diffuse disease to a maximum of 90%
RCA:RCA has ostial 80% stenosis
PDA/PLV: PDA has a tubular 70% stenosis
LV: not done

[ed34]

There are three major coronary arteries and to have a tight blockage in two of them would be a concern. The left front of the heart is supplied by the LAD and the rear left by the LCx. With both tight blockages occurring I would think that on exertion, a considerable area of heart muscle is under stress. The OM1 also has a tight restriction but this is an extension of the LCx. If there are no symptoms in the patient in the form of angina, I would be very surprised.

[THIPPANSIVAKUMAR]

My father has mid LAD complex trifurcation (1:1:1) 90% stenosis. LCX in the AV groove has tubular trifurcation 90% stenosis involving ostium of OM1. OM1 has ostial 95% stenosis.

How serious is the case. Please advice

[Rogergarrido]

After two angiography in 2006 and 2007 I have more problems and the last diagnoses is Angio:80% stenosis of the RCA,in stent restenosis LAD, and the doctor tell me i need a Bypass.
I seek for suggestion from you for this situation

Kind Regards
ROGER

[ed34]

then I am at a loss why you would post the angio report

[jhinisp]

Thank you. Doc says his heart muscles are strong. But I am afraid of his lungs which are relatively weak.

[ed34]

Well there is a lot of disease here. Let's look at each vessel in turn. First the left anterior descending (LAD). From what I can tell, this vessel is clear, apart from one of its branches (Diagonal) which is completely blocked. If completely blocked then there is no point in intervention. Either some muscle has died, or the Heart has opened natural bypass vessels to cope with this. A nuclear scan is required to establish the answers. Now the left Circumflex (LcX). This is non-dominant so quite a short vessel, but it is restricted by a 90% blockage at the top. This needs to be stented or bypassed. As we travel down this vessel we reach the Obtuse Marginal 1 and it is blocked by 95%. A marginal branch off the Obtuse marginal is also blocked totally. I should think that this vessel would be giving some angina symptoms. Now the Right Coronary Artery (RCA) which is 80% blocked near the bottom. This is a dominant vessel and so is very long, probably supplying the PDA at the rear of the heart. I think that the best thing to do is to have a nuclear scan and establish the areas which are not receiving enough blood. The RCA could also be supplied by collateral vessels and bypass/stents may not be necessary on this vessel. I would think that out of all the vessels, the LcX would require intervention.

[jhinisp]

My 75 year old father asked to undergo bypass.
His angiography report says

LAD/Diagonal
totally occluded from ostial segment

LCX/OM
Non-domin angiography.  90% STENOSIS in proximal segment.  Multiple minor plaque along the course of LCX.

OMI 95% stenosis in proximal segment.  One branch of OM is occluded.

RcA: Dominant.  Multiple minor plaque along the course of RCA. 80% stenosis in distal segment

[ed34]

The only real concern at the moment is the middle of the left circumflex at 80% which is probably giving angina (chest pains). Perhaps a stent to this region if possible? which will give a greater possibility to develop collaterals across to the other major vessels. It might be worth OM1 being stented also because this is really a part of the left circumflex.
Lifestyle changes are of course necessary now, to prevent the other blockages getting worse.
This is just my personal opinion as you have triple heart disease.

[nalin09]

Chest pain on 12th feb ... as per ecg there no attack ... and the report shows as per above ....
need an opinion

[ed34]

what symptoms do you have?

[nalin09]

Left main : ostial left main has 70% stenosis

Ramus : ostial segment has 70% stenosis

lcx :- dominant, proximal lcx has 30% plaque
       mid lcx has 80% stenosis
       om1 has 70% stenosis

Rca : Non Dominanat,normal

renals : left renal has 30 % plaque
            right renal normal

i have the this report @ angiography
can u plz suggest me

[ed34]

I am not a Doctor, but looking at your report I am a bit confused. It is missing a fair amount of detail, such as the amount of plaque in the LAD vessel. It simply says "Plaquing". The main issue appears to be the Obtuse Marginal vessel OM which is 90% blocked at a junction with another vessel. I have no idea why they cannot stent this? Your heart is certainly not DAMAGED? your LVEF is 60% which is absolutely fine and your heart muscle is moving just fine. In fact the report states LV No-RWMA which is Left Ventricle, there are NO Regional Wall Motion Abnormalities. It then says NORMAL left ventricle systolic function. So your heart is working fine, so what is the emergency and where is the severe damage?
I would be a bit concerned about the 90% blockage, because this can be causing some symptoms of Angina on exertion. Other than that, I would ask about medication and lifestyle changes. I have the impression that you have probably formed some collateral feeds on your heart, which are natural bypasses. I know if this was my body and I had to make a choice, I would say stent the 90% blockage and I'm out of here. I would want good medication such as statins and beta blockers, and I would make a lot of lifestyle changes including a really healthy diet. I would then see how things progress from there. If you start to get symptoms again, then it's time for another angiogram, but technology in angioplasty is improving all the time. Remember though, I am not a Doctor, and I cannot tell you what decision to make. I can only say what I would do.

[GSKBLR]

Lmca-Normal
Lad-Type 3 vesel,proximal LAD shows plaquing,mid and distal LAD diffusely diseased.
Diagonals-Diseased
Lcx-Non dominant,proximal LCX shows non critical plaquing,continues as Major OM
Marginals-Major OM -proximal non critical plaquing,mid-distal 90% bifurcation lesion
Rca-Dominant,Proximal RCA shows non critical Plaquing,Mid&Distal RCA diffusely diseased.
PDA/PLV-Diseased
LV-no RWMA,Normal LV systolic function,LVEF-60%
Final Digonosis-CAD-Normal LV systolic Function

Dear Sir
Please guide me what is the solution doctor told its severly damged nothing can be done they are discussing with surgon.I am showing in Naryana Hrudayalaya.Please guide me what is the solution and next step .IIs CABG is the solution.my email is ***@**** we are in hospital please guide me.

[ed34]

Your Father certainly does have a lot of coronary artery disease, many vessels are affected. I would have to ask how they intend to feed the heart muscle using bypasses when most areas are seriously blocked off. The distal LAD is one common area for a feed, but this is heavily diseased. The report does say how the complete blockage in the MID right coronary artery has bridged with collaterals (natural bypass vessels). I would also have to guess this is happening to many other blockages or he would be very seriously ill due to the left side of the heart being so short of oxygen.
Have they mentioned anything about a Nuclear scan to establish which area/s are causing the problem, giving a better guide where to attach the bypass vessels? It could be that one vessel is giving a lot of collateral feeds but due to disease this has reduced, meaning only that one vessel would need bypass. A nuclear scan shows which areas of the heart muscle are not receiving the right amount of oxygen. An angiogram doesn't give this information because most collateral feeds are far too small to be seen.