miyocardial cell damage

[shriram1]

My dad is 74.he had 2 stents 8 months ago.the doc says he has to undergo bypass surgery.now 50%miyocardial damage in lad.so it is risky his ef is around 30%. please advice

[ed34]

It looks like they are a bit confused? First it states that a perfusion defect is shown, and there is a lot of dead muscle at the front lower left side of the heart, and the septum, separating the left and right ventricles. Then it says that the muscle is not dead, but is viable. This means recoverable. It goes on to say that the LAD is the culprit.
Are both these conclusions from the same scan????
I think the best scan would have been a nuclear perfusion scan, not an MRI. While the MRI may give some indication of heart muscle condition (not always conclusive), a nuclear scan shows where blood is actually managing to reach.
If I was in your shoes I would get an appointment with the cardiologist as soon as possible and find out what the heck is going on. I would ask what tests they intend to do and certainly I would recommend a Nuclear scan. The sooner they get a better blood flow to that muscle, if they've finally concluded it's viable, the more chance there is of saving it. When is your next appointment?

[shriram1]

Any idea what the above says. The above is the impression of the mri report

[shriram1]

What exactly is this:

Perfusion Defects Involving the interventricular septum, apex and anterior walls with abnormal delayed enhancement as described - LAD - Infracted non viable myocardiam (25% thickness of anterior walls and 75% thickness of the apex & inferior part of the interventricular septum.

Mismatch between perfusion defect & delayed enhancement in anterior wall and the superior part of the interventricular ssystem - Viable myocardiam. (lad teritory)

[ed34]

I assume his EF is still adequate on the left side of the heart, i.e. the amount of blood being ejected with each beat. With regards to the loss of 50% of muscle, the effects are usually discovered more long term. I'm not sure what they hope to gain with bypass surgery. If the muscle is dead, then there is no way the muscle will regenerate so it's a waste of time. Perhaps the Doctors feel that the dead muscle is just on the surface, and not all the way through the thickness of the wall. I think I would ask what they hope to accomplish with the surgery.
Your last post about LAD and RCA only, I don't think that's true, not here in the UK anyway. Here, they tend to concentrate more on the LAD and LCx, and not the RCA unless there are serious pulmonary issues. I had several stents in my LCx which caused collateral growth across to my blocked LAD. You can get some pretty nasty angina symptoms with a blockage in the LCx, it used to give me terrible throat/jaw/chest pains.

[shriram1]

If there is a 75% block in LCX is it major. Why ppl concentrate in LAD and RCA regions only.

[shriram1]

As i understand the muscle fed by the LAD is 50% dead. ie it is non viable. What impact does it have. Does it mean that the bypass surgery will be useful if there is 50% damage.

[ed34]

Sorry, I'm confused with your question. You say the myocardial is damaged in LAD 50% ?  Myocardium is the heart muscle, the LAD is an artery. Are you saying the artery is 50% blocked? or are you saying the muscle fed by the LAD is 50% dead?