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LAD occlusion
Hi Dr,
My mother had a MI with 100% occlusion the LAD and 80% to diagonal. RCA and Circ had mild disease. He opted to stent the diagnol lesion only because he said he could not identify and cannulate the LAD because of the blockage. She continued to have Chest pain post stenting that later subsided. I asked him if she was a candidate for CABG and he said no because "you have to an artery". What does that mean? What else could have been done for a more optimal longterm outcome? I did research and the know mortality rate for LAD occlusion is very high. Is this something that can be managed with just medicines. Her EF is 45% with apical hypokensis.
My mother had a MI with 100% occlusion the LAD and 80% to diagonal. RCA and Circ had mild disease. He opted to stent the diagnol lesion only because he said he could not identify and cannulate the LAD because of the blockage. She continued to have Chest pain post stenting that later subsided. I asked him if she was a candidate for CABG and he said no because "you have to an artery". What does that mean? What else could have been done for a more optimal longterm outcome? I did research and the know mortality rate for LAD occlusion is very high. Is this something that can be managed with just medicines. Her EF is 45% with apical hypokensis.
thank u...he had the widow maker MI in feb 2010...currently he has been having "aches" aroun the heart...the Mi caused so much damage to the left ventricle that it is very akentic...and he does have cardiomyopathy due to the MI....he has had 3 TIA'S....had an AICD placed due to bradycardia and could not take the beta meds to increase his EF....is on effient....if anyone is on plavix..please have the blood test to see if it is working...it was NOT working on my husband...thus the TIA'S....effient is workng well.....appreciate any comments....
I just recently read mortality rate is 10 to 15% per year for systolic heart failure (low LV EF) and less for diastolic heart failure. Diastolic heart failure is due to the inability of the left ventricle heart muscle to relax during the heart's filling phase causing less blood to be pumped into circulation with each heartbeat.
Sometimes chest pain can be helpful as it gives an individual notice there may be occluded vessels that do not provide sufficient blood to certain areas of the heart. And apparently your husband has heart wall movement impairment that reduces the heart's ability to adequately pump designated by the low EF.
You didn't state when your husband had the stent implants, and whether or not there is/was an enlarged heart. An enlarged heart can/will reduced the EF, and medication can decrease heart's size and return the EF to normal, but that depends on the underlying problem and may take a few months or so.
Hope this helps, and thanks for sharing your husband's experience. Take care.
Sometimes chest pain can be helpful as it gives an individual notice there may be occluded vessels that do not provide sufficient blood to certain areas of the heart. And apparently your husband has heart wall movement impairment that reduces the heart's ability to adequately pump designated by the low EF.
You didn't state when your husband had the stent implants, and whether or not there is/was an enlarged heart. An enlarged heart can/will reduced the EF, and medication can decrease heart's size and return the EF to normal, but that depends on the underlying problem and may take a few months or so.
Hope this helps, and thanks for sharing your husband's experience. Take care.
my husband had a widow maker MI with a 100% lad -99% rca and 90% circ..he had and aginoplasty and 2 stents..the lad and rca were both up high...close to the aorta...the only choice was stents due to time....his ef is still only 25-30 %..what is the mortality rate for this situation...his only systom was sob...ever...no pain.....only history is genetic high cholestrol...any suggestions
I have 100% occlusion of the LAD for at least 5 years inaddition to a 72% blocked (at that time 5 years ago) circumflex. I do well with medication. What is favorable isyour mother's EF is 45% (amount of blood/oxygen pumped with each sroke), and that is just below normal and with a margin of error. One's EF is not a stable measurement, but it varies as does the heart rate to maintain equilibrium of blood to the lungs needing oxygen and blood/oxygen pumped into circulation. And the report of hypokinesis indicates heart cells may well respond to treatment as opposed to akinesis where the heart cells are dead (necrotic).
Long term outlook depends on the underlying cause for the hypokinesis as this condition weakens heart contractions and can in part explain the less than normal 45% EF. Without a doubt your mother's hemodynamics are good regarding the 100% LAD occlusion, and there is sufficient blood flow to the deficit area.
I was told I had had a heart attack, and my EF was 13 to 29% when I went to emergency for what I thought was a respiratory problem. An echo indicated an enlarged (remodeled) left ventricle..treatment reversed remodeling and my EF is now 59% (5 months ago). Your mother should have an echocardiogram to determine heart chamber size. A CABG would not be indicated as the LAD is still functioning as a vessel supplying blood although there maybe some rerouting of blood flow within certain segments of the LAD. The 80%blockage may be treated with medications if that relieves symptoms, or a stent....it wouldn't be necessary to surgically bypass from what you report.
Long term outlook depends on the underlying cause for the hypokinesis as this condition weakens heart contractions and can in part explain the less than normal 45% EF. Without a doubt your mother's hemodynamics are good regarding the 100% LAD occlusion, and there is sufficient blood flow to the deficit area.
I was told I had had a heart attack, and my EF was 13 to 29% when I went to emergency for what I thought was a respiratory problem. An echo indicated an enlarged (remodeled) left ventricle..treatment reversed remodeling and my EF is now 59% (5 months ago). Your mother should have an echocardiogram to determine heart chamber size. A CABG would not be indicated as the LAD is still functioning as a vessel supplying blood although there maybe some rerouting of blood flow within certain segments of the LAD. The 80%blockage may be treated with medications if that relieves symptoms, or a stent....it wouldn't be necessary to surgically bypass from what you report.
Just to add. If the LAD is 100% blocked, it must be obtaining a feed from somewhere, probably through adaptations called collaterals which are small blood vessels that grow across to supply Oxygen to the deprived tissue.
Without having more details of the occlusiion in the LAD is would be difficult to speculate. Do you know where in the LAD the blockage is? how long the blockage is?
If the entire vessel is thickly coated with Plaque then it is unlikely that a bypass will work because no matter where you graft to the vessel, blood will not get through.
Last year I was given an unusual option for my LAD which I turned down but my situation was different. The option was an open end type endarterectomy. However, to discuss this you will have to see a Heart surgeon, not a Cardiologist limited to performing Angioplasty, they are two very different skill sets. An open end type arterectomy involves making an incision in the end of the LAD and pulling out the entire inner layer, and the disease with it. Restenosis can be a problem and this carries quite a few risks. It might be worth a discussion but in the meantime it would be good if you could obtain more info on the LAD condition. In the UK you can buy a copy of your Angiogram and run it on your PC for quite a low cost. I'm not sure if you have the same option.
If the entire vessel is thickly coated with Plaque then it is unlikely that a bypass will work because no matter where you graft to the vessel, blood will not get through.
Last year I was given an unusual option for my LAD which I turned down but my situation was different. The option was an open end type endarterectomy. However, to discuss this you will have to see a Heart surgeon, not a Cardiologist limited to performing Angioplasty, they are two very different skill sets. An open end type arterectomy involves making an incision in the end of the LAD and pulling out the entire inner layer, and the disease with it. Restenosis can be a problem and this carries quite a few risks. It might be worth a discussion but in the meantime it would be good if you could obtain more info on the LAD condition. In the UK you can buy a copy of your Angiogram and run it on your PC for quite a low cost. I'm not sure if you have the same option.
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