is bypass compulsory ?

[ssccs]

My angiography report said following :
LMCA : Ostial Plaque
LAD:     Diffuyse disease in mid part sequenmtial lesion of 60%, 50% & 80% in mid to distal LAD.
LCX :     Co-dominant 60% lesion in distal past before last major OM.
RCA:    Total occlusion after conal branch. Distally PD filled by GP.III collaterals from LAD.
LV: 55% (on echo)
CAD:  Triple vessel disease.
Fair LV Function.
Hyertension
Effort Angina.
Diabetes Mellitus
Moderate PAH (On echo)
Is medicine management sufficient or I have to go for bypass ?
Please advise

[ssccs]

Thank you for your kind reply. At present by BP is 151/81 and pulse 78. I take following medicine since 30 days.
1]  morning  :
   1. Valzar (160)                  1
   2. Lacillactone                 1
   3. Cardivas (3.125)         1
   4. Flavedar MR              1
   5. ISORDIL 10mg           1         to be swallow
    6. Glycomet GP-1          1

[2} NOON  :
    1. Lacillactone            1
    2. ISORDIL 10mg       1         to be swallow
    3. Ecosprin 75            1
    4. NUROKIND PLUS           1
(3)NIGHT :
   1. Valzar (160)                1
   2. Minipress (2.5)          1
   3. Cardivas (3.125)         1
   4. Flavedar MR              1
   5. ISORDIL 10mg           1   to be swallow
   6. Atorsave (40)             1
   7. Apresol (25)               1
   8. Glycomet GP-1           1
   9. miraqule 100             1

(4) At 11.30 night :
   ISORDIL 10mg                1   to be swallow

I do not feel any symtums while walking or working but when I think about bypass, i feel slight burning in the chest but if I concentrate my mind in another matter, the burning is gone.

What type of symptums lead me to bypass ? means when should I opt for operation ?
-ssccs

[ed34]

Nothing is compulsory, it's your body and you make the final decisions on anything. Having said that, you are diabetic. If I remember correctly, Diabetics have a much better outcome, short and long term, from bypass surgery over stenting. Diabetics tend to restenose stents more frequently. Looking at your report, I think there's too much work involved to stent everything, making it much more risky. Your LAD for example is sequentially diseased from the middle all the way to the bottom and you have disease forming in the Left main coronary artery. The circumflex is forming a blockage near the bottom, and the right coronary artery is totally blocked. It would take a box of stents to treat that lot and I would be surprised if any cardiologist would be willing to take it on.
Should you have bypass or medication? Well, that's a tough question because we don't really know how bad your symptoms are. If it was me, I would take the medication for as long as it works, but as soon as your symptoms worsen, have a rethink. I wouldn't just keep increasing my meds, as soon as my condition gets worse, I would go for intervention.
How long the meds hold off bypass surgery is anyones guess. You could go on for weeks/months or the rest of your natural life without needing surgery, but you will have to make some BIG lifestyle changes to stop the disease progressing. Diet change, keep blood pressure down, keep cholesterol checked and low, exercise regularly (even if just walking every day), avoid stress and go to the hospital if you feel worse at any time.
I wish you well.

[jrbon]

Is there any particular reason why angioplasty with stens is not an option?

In any case I suppose that the decision is always yours, mainly depending on your symptoms.

Jesus