Need your opinion on Stenosis

[Indug]

Dear All,
My Mother, 64 yrs old, having a family history of heart diseases has been diagnosed with the following in a CT angio scan done 2 days ago.

1. Diffused disease with 50% Stenosis of proximal LAD
2. 90% stenosis of mid LAD
3.90% stenosis of origin D1
4.80% stenosis of origin OM1

My mothet has BP (which is under control with medicines and diet) and is not diabetic.
Please tell me the gravity of the matter and if she reguires to underho surgery?

Best regards
Indu

[jja123]

Ken sinse the circumflex is 90 % block is it possible for new vesseles to grow around the by-pass if not then how is the blood flowing freely. THANKS JJ

[ed34]

If you are still getting Angina symptoms then you would have to assume that there is a blood flow problem still. Seeing a 90% blockage in your circumflex makes you wonder why they would say everything is fine, when this is likely to be the cause. I think maybe you should get a second opinion on their decision. I have had three blockages in total in the LCX and I have to say it causes much more discomfort than blockages in my other vessels, it seems to give me a nasty throat discomfort followed by chest pain and shortness of breath.
You should look at your lifestyle and see if you can establish what is causing your blockages. Are you under a lot of stress? or are you eating an unhealthy diet? Do you smoke?

[kenkeith]

Many individuals have chest pain (angina pectoris) with a blockage greater than 70%.  However, some individuals do not exerience angina with blockages, nor any asscociated symptoms with vessel blockage.  I didn't experience any symptoms from occluded vessels until I had heart failure. I'm sure your doctors are aware of that and take that into consideration.  If there was/is a problem,  heart cells that do not get enough oxygenated blood will impair heart wall movement. My echo showed hypokinesis (heart wall movement disorder), and that is the effect of a heart blockage. If there is a concern, you should have that test.  I have had 72% ICX blockage for the past 7 years, and I take a nitrate prior to working out in the health center to prevent angina.

It could be that your bypass is providing sufficient blood flow to areas normally supplied by the circumflex, and or other vessels have developed to flow into the area is another possibility. There almost has to be a medical problem with 90% blockage under the usual circumstances...are you taking a nitrate for chest pain?

Thanks for sharing, and if you have any further questions or comments, you are welcome to respond.  Take care,

Ken

[jja123]

Back in 2003 I had a double by pass which I still have angina had another angiagram done in 2009 showing a 60 % blockage in the circumflex and just recently had another angiagram done in Jan of this year which showed the circumflex proxiam segment 90% stenosis but was told that there was nothing wrong with the heart everything is fine. How can everything be fine with a 90% stenosis in the circumflex? Thanks for your help in adv. j.jones

[kenkeith]

You should get an answer to the underlying casuse for your shortness of breath and fatigue to rule out heart failure.  An echocardiogram would be appropriate to measure heart chamber size, heart wall movement, ejection fraction (amount of blood pumped into circulation with each heartbeat).  Shortness of breath was the only symptom required for an emergency evaluation...I was shoclked to learn I had heart failure!
.  

[grammydeer]

I have a totally blocked LAD that did not respond to EECP.  So far none of the medications have made a difference.  My symptoms are shortness of breath and exhaustion.  Do you have any suggestions?

[kenkeith]

Whether there should be intervention (stent, CABG) depends on your mother's symptoms, and whether or not mediction can dilate the the partially occluded vessels.  If there is angina (chest pain) that would indicate a reduction of oxygenated blood reaching the heart cells, and if there is relief from angina with medfication that may indicate sufficient blood is getting to the location in question.  Some individuals cannot tolerate medication so that would be a consideration as well.

I have a totally blocked LAD and partially blocked circumflex that is successfully treated with medication for the past 5 years.