Aa
Time for another catheterization?
I am a 59 year old male. In 1997 I had a heart cath done at Emory Heart Center in Atlanta results were as follows.
Left Coronary artery has diffuse luminal irregularity. The proximal LAD before the first branch has a 30-40% stenosis. LM is very short. Ramus is normal.
Right Coronary artery is angiographically normal.
Since that time I have observed a diet with much less fat and red meats and have exercised regularly each week.
My last HDL was 51 LDLC was 118 and Triglycerides 55 Cholesterol 180
What is the best way for me to know if this artery has progressed further with disease? Are there any options other than another heart catheterization?
Thanks
James
Florence SC
Left Coronary artery has diffuse luminal irregularity. The proximal LAD before the first branch has a 30-40% stenosis. LM is very short. Ramus is normal.
Right Coronary artery is angiographically normal.
Since that time I have observed a diet with much less fat and red meats and have exercised regularly each week.
My last HDL was 51 LDLC was 118 and Triglycerides 55 Cholesterol 180
What is the best way for me to know if this artery has progressed further with disease? Are there any options other than another heart catheterization?
Thanks
James
Florence SC
You don't book another cath. The bottom line is, you have the problems (current) treated as best as possible, and then you change your diet/life style to try and stop the progression of the disease. You take the correct medication to help and in particular try to avoid stress. You have to keep your blood pressure under control to prevent further damage to your arteries. We all wonder what's going on inside out arteries but there is one factor doctors rely on for feedback on this, that's our symptoms. If symptoms return or worsen, then obviously something has happened to warrant investigation. At the end of the day this means our life style changes/diet changes/avoidance of stress and control of blood pressure wasn't adhered to. I'm very strict now and if I feel myself getting angry, I take a deep breath and think "hang on, this is going to make me ill, is it worth it". We can't keep having angiograms, like kenkeith says it would be too risky.
Tests 4 years ago showed I had a totally blocked LAD, 98% blockage of the RCA (stented) and 72% blocked ICX. Recent ct angiogram shows no problem with ICX, normal blood flow into and out of the RCA stent and LAD collateral vessels (natural bypass) are not seen. To have had 3 caths in the interim of 1 to 4 years is an unnecessary risk and expense, especially if there are no symptoms.
If you or anyone that is at a risk (especiallly family history), a ct angiogram will show the risk before there is calculus in the lumen of the vessel seen by a cath. Plaque begins at a very early age (large majority) and doesn't occlude the lumen until around 40 years old. If there is a family history or vulnerability to CAD, the individual should begin treatment, proper diet, exercise, life style amenity, etc. BEFORE the occlusions you allude to. Unfortunately, there are a small minority that nothing appears to prevent CAD. and for some there may be medication intolerance. For this small minority intervention may be the only remedy, but CAD will likely appear and continued intervention is required.
A cath each year for the majority of individuals is an unnecessary risk...there are exceptions!
If you or anyone that is at a risk (especiallly family history), a ct angiogram will show the risk before there is calculus in the lumen of the vessel seen by a cath. Plaque begins at a very early age (large majority) and doesn't occlude the lumen until around 40 years old. If there is a family history or vulnerability to CAD, the individual should begin treatment, proper diet, exercise, life style amenity, etc. BEFORE the occlusions you allude to. Unfortunately, there are a small minority that nothing appears to prevent CAD. and for some there may be medication intolerance. For this small minority intervention may be the only remedy, but CAD will likely appear and continued intervention is required.
A cath each year for the majority of individuals is an unnecessary risk...there are exceptions!
I guess it would have been nice to know about all the blockages before they became so bad that nothing can be done. I guess it would have been nice to have had the chance to have stents or another bypass surgery to repair partially occluded vessels before they became so bad that nothing can be done. Not my opinions, 3 different doctors (competent) opinions. I am just the guy that has to live with the end results.
I would have gladly taken on the risk factors and had multiple caths, stents, angioplasty, bypass etc etc rather than being left with only the choice of a pump or a transplant. It would have been nice to know about the progression of plaque buildup rather than finding out 5 years later that there isn't very much that can be done. Regular (serial) caths would have been beneficial in my case.
I would have gladly taken on the risk factors and had multiple caths, stents, angioplasty, bypass etc etc rather than being left with only the choice of a pump or a transplant. It would have been nice to know about the progression of plaque buildup rather than finding out 5 years later that there isn't very much that can be done. Regular (serial) caths would have been beneficial in my case.
QUOTE: "To make this a shorter post, I would suggest having a cath done regularly as it seems, at least from what I learned, that it is the only thing that really tells you and the doctors what is really going on. I was recently told that I could expect to have a cath done regularly from now on and I guess I am glad about that".
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Serial caths are absolutely unnecessary and the interventional risk out weighs any benefits especially when there are no symptoms!. ACC/AHA guidelines do not recommend stenting blockages less than 70%. If one has uncontrolled angina not corrected with medication, then it is recommended to stent implants less than 70%.
The COURAGE medical study (evaluated outcomes of 3 different procedures) shows that longivity is not increased and about the same for bypass, stents and medication. I have a totally blocked LAD (natural bypass with collateral vessels) and a 72% ICX and I do very well with medication. A nitrate medication prevents angina during my rigorous workout days otherwise normal daily activities do not produce angina.
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QUOTE: "What I was told is that is all great and good but Nothing I do or they do can stop the plaque that was already present from breaking off and plugging up my heart".
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Any competent cardiologist will tell you that it isn't the plaque that is viewed in the lumen (causes ischemia) with a cath that presents the danger of a heart attack or stroke. It is the unseen plaque that that resides within the inner and outer layer of the vessel that is the risk for a heart attack or stroke. The unseen plaque ruptures and causes a clot and the clot causes the fatality. A serial CT angiogram (non-invasive) is able to view the cross section of the vessels and determine the degree of soft plaque (referred to medically as unstable plaque) and the other plague, and plaque is dynamic that changes form soft plaque to hard plaque and visa versa, and there are claims that medication can stop the progression of plaque and even reduce.
The ct angiogram software calculates a numerical score for those that are vulneralbe and those with ;less risk of a major heart event within year and up to 5 years. Serial ct angiograms can determine if there is plaque progress or regression...cath only views the lumen and has no predictability for a future heart event, and only indicate if there is an occlusion that may cause ischemia resulting in pain and sometimes no pain.
________________________________________________
Serial caths are absolutely unnecessary and the interventional risk out weighs any benefits especially when there are no symptoms!. ACC/AHA guidelines do not recommend stenting blockages less than 70%. If one has uncontrolled angina not corrected with medication, then it is recommended to stent implants less than 70%.
The COURAGE medical study (evaluated outcomes of 3 different procedures) shows that longivity is not increased and about the same for bypass, stents and medication. I have a totally blocked LAD (natural bypass with collateral vessels) and a 72% ICX and I do very well with medication. A nitrate medication prevents angina during my rigorous workout days otherwise normal daily activities do not produce angina.
______________________________________________
QUOTE: "What I was told is that is all great and good but Nothing I do or they do can stop the plaque that was already present from breaking off and plugging up my heart".
________________________________________________
Any competent cardiologist will tell you that it isn't the plaque that is viewed in the lumen (causes ischemia) with a cath that presents the danger of a heart attack or stroke. It is the unseen plaque that that resides within the inner and outer layer of the vessel that is the risk for a heart attack or stroke. The unseen plaque ruptures and causes a clot and the clot causes the fatality. A serial CT angiogram (non-invasive) is able to view the cross section of the vessels and determine the degree of soft plaque (referred to medically as unstable plaque) and the other plague, and plaque is dynamic that changes form soft plaque to hard plaque and visa versa, and there are claims that medication can stop the progression of plaque and even reduce.
The ct angiogram software calculates a numerical score for those that are vulneralbe and those with ;less risk of a major heart event within year and up to 5 years. Serial ct angiograms can determine if there is plaque progress or regression...cath only views the lumen and has no predictability for a future heart event, and only indicate if there is an occlusion that may cause ischemia resulting in pain and sometimes no pain.
I had my first cath done in 2003 during a heart attack. That cath showed 5 major blockages that were then bypassed. Since that time I have had many CT scans and nuclear stress tests that didn't show any blockages.
In February I started feeling a little off and tired and began having significant angina. They did a double heart cath at that time that showed alot of blockages. 4 off the 5 bypassed vessels are 100% blocked as well as numerous collateral blockages. They couldn't stent any of these because of (in their words) severe heart disease. They only good news was that my internal pressures were low and the main arterial graft was open and only had minimal plaque buildup. In the 5 years since the first heart cath I have had excellent lipid panels with only the HDL being borderline. I have exercised everyday, watch what I eat and tried to live a heart healthy lifestyle.
What I was told is that is all great and good but Nothing I do or they do can stop the plaque that was already present from breaking off and plugging up my heart.
To make this a shorter post, I would suggest having a cath done regularly as it seems, at least from what I learned, that it is the only thing that really tells you and the doctors what is really going on. I was recently told that I could expect to have a cath done regularly from now on and I guess I am glad about that.
In February I started feeling a little off and tired and began having significant angina. They did a double heart cath at that time that showed alot of blockages. 4 off the 5 bypassed vessels are 100% blocked as well as numerous collateral blockages. They couldn't stent any of these because of (in their words) severe heart disease. They only good news was that my internal pressures were low and the main arterial graft was open and only had minimal plaque buildup. In the 5 years since the first heart cath I have had excellent lipid panels with only the HDL being borderline. I have exercised everyday, watch what I eat and tried to live a heart healthy lifestyle.
What I was told is that is all great and good but Nothing I do or they do can stop the plaque that was already present from breaking off and plugging up my heart.
To make this a shorter post, I would suggest having a cath done regularly as it seems, at least from what I learned, that it is the only thing that really tells you and the doctors what is really going on. I was recently told that I could expect to have a cath done regularly from now on and I guess I am glad about that.
A 64 slice CT angiography shows the anatomy and whether or not the vessel has remodeled. The vessel will remodel when there is plaque present, and by remodeling the lumen (inside diameter) stays open and appears to be no problem when viewed with a cath. However, the plaque that is not seen can rupture the intima (inner lining) and cause a clot causing thrombosis or begin a buildup of plaque that can occlude the vessel.
By viewing the lumen does not give the full picture, it is area between the layers of tissue between inner and outer that is dynamic and a better indication of any progression or lack thereof of plaque.
By viewing the lumen does not give the full picture, it is area between the layers of tissue between inner and outer that is dynamic and a better indication of any progression or lack thereof of plaque.
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