When do you have Bypass surgery?

[SillyLilRose]

My husband was diagnosed last month with coronary artery disease at age 53. He had a metal stent placed in the left circumflex artery. At that time I, along with 3 other family members were told he had 75% blockage in that artery but further on where that artery branches out, there's alot of blockage & he would need bypass surgery with in 6 months. He also has 50% blockage in 2 other arteries & alot of blockage through out the areas that branch out in his heart. He also has been having alot of pain in his legs & feet as well & the Doctor believes he has clogged arteries in his legs too. He's been a smoker since he was 15yrs old however he is trying to quit. Coronary artery disease runs in his family on his fathers side & his sister had a heart attack at age 45 & his father died of a massive heart attack at age 50. He recently went back to see his cardiologist & I had asked about when they were planning on doing the bypass surgery. The doctor replied, "Well you don't have health insurance & bypass surgery costs alot so he'll need it sometime in the future but not now at this point". What the heck?
Also after his stent was placed which was 30 days ago, he still doesn't feel any better & he still sleeps alot & tired all the time with sharp chest pain of & on & still breaks out in sweat for no reason & still has shortness of breath. So I guess my question would be..when is bypass surgery done? When a person has a massive heart attack? He certainly can't work in his condition. I'm a natural worry wart & I am so stressed out & worrying so much about him!

[kenkeith]

My 100% LAD blockage is located off the branch of the LMA and the circumflex (the other branch) is 72% blocked (5 years ago according to angiogram and echo).  At that time the RCA was 98% stented and it help feed into the left distal side (angiogenesis) . The LAD is and was100% blocked, and the cardiovascular system developed collateral vessels as obviously one can not survive a deficit of blood flow to a large portion of the heart.

Isosorbide, 10 mg, is my nitrate of choice prior to workout at gym (I dont go to the gym with symptoms as you state...med prior prevents symptoms).   Occassionally, a sublinqual netro when unexpected strenuous activity occurs (shoveling snow for example).

You are incorrect when you state one cannot survive having a 100% blockage of the LAD. Also, there can be no angina with seriously blocked coronary arteries.  I had no symptoms of CAD until I had a (silent) heart attack...symptoms at that time were shortness of breath, dry cough at night due to edema, etc....Many people experencing no angina with CAD are often people with diabetes and older people.  I don't have diabetes, always proper weight, healthy diet, exercise, etc., slow development of CAD may have provided time for my system to compensate and that would be an important factor.    

If you have angina at rest, that is unstable angina,  and I'm not surprised with that condition if you only have 2 tiny vessels.  I have stable angina and (only) chest discomfort with exertion.

[ed34]

just to add that I believe stents are worth it. My left circumflex had a blockage causing heart attacks and I was unable to eat because the extra demand from the digestive system was overloading my heart. I noticed an immediate massive improvement straight after the stent was fitted. Two years later my new angiogram reveals the drug eluting stent is still holding the artery fully patent with no sign of restenosis.
I am intrigued as to how kenkeith manages to go to the gym with no symptoms and a 100% blocked LAD. This vessel is known as the widow maker because it is vital to the
left side of the heart. I have two tiny new vessels which adapted to feed the LAD but only
enough to satisfy the heart at rest. Any exertion causes severe angina. Nitrates do not work because they cannot get past the blockage to open the LAD.

[kenkeith]

QUOTE: "So I guess my question would be..when is bypass surgery done? When a person has a massive heart attack? He certainly can't work in his condition. I'm a natural worry wart & I am so stressed out & worrying so much about him! "

The American Hosptital Association (AHA) and the American Academy of Cardiology (ACC) have published quidelines for CAD.  If the lesion is less than 70%, no treatment necessary.  If the blockage is greater than 70%, treat with medication, and if medication does not control symptoms then stent implants.  In the event of an emergency of an ischemic heart attack, an CABG is necessry.  Also CABG for lesions to large, complex and complicated due to location, many lesions, etc. than CABG is appropriate.

All treatment for CAD (medication, stent and CABG) are symptom related,  and does not cure, nor increase life span.  If your husband's recent symptoms are related to ischemia and not controlled with medication, then CABG.  Shortness of breath, etc. can be related to smoking, poor physical condition, etc. and a bypass would not make a significant change.

I have had 100% blockage of the LAD and 72% blockage of the circumflex for more than 6 years and treated with mediation, exercise, proper diet, etc.  I take a nitrate for angina prior to going to the gym and have no symptoms.  I recently mowed my lawn without a nitrate and that is an improvement as prior I would need a nitrate.  

[westfield60]

I agree that he should try and get the surgery sooner than later. It is really sad that we cannot get sometype of health coverage for everyone these days. In times when we are bailing out banks with trillions we really should as a country decide to offer affordable health care to everyone. Your husband really needs this.

[mammo]

With your husband having the artery disease, his arteries are clogging throughout his entire body.  The pain in his legs is also a result of plaque build-up and cutting off the blood flow to his legs.  It's a shame he didn't stop smoking long ago, as once you stop, your lungs start repairing themselves, but the damage to your cardio-vascular system is forever.  Plus, he has heredity working against him.  It sad, but he won't be able to get the care needed without a way to pay for it.  Can you get Medicaid Medical coverage for him?  This is his only hope, and I would look into this.  I'm beginning to wonder if stents are ever a good idea.  My husband has 2 (in his legs) plus he had surgery to clean the plaque out of his arteries in his groin, and he is no better, after promises of "big improvement!"  Is your husband a veteran?  If so he can go to the VA for his care.  I feel so bad for both of you, with you not having insurance, what is one to do?  This is becoming a growing problem in our country, something needs to be done.  I hope you can get a medical card for him, it seems like an awful lot of people who are capable of working has one, just because they are too lazy to work.  But let someone who truly needs it, try to get one, and what a fight!  Good luck to you, and I certainly understand why you worry.