small to moderate ischemia

[bbuster]

I am so hoping someone might respond!! I have af but it is controlled with sotalol and digoxin... I had a perfusuin stress test today - m they called and told me I showed small to moderate ischemia - I am a female. What does this mean in regard to blockage. what is the treatment? What does small to moderate equate to - 20%, 50%, what. Thanks in advance

[kenkeith]

The AFCAS is an ongoing gov. study, and reading your post, I thought there may be more information available on the issue!  

[ed34]

Yes I believe there was a study done to show the effects of anti thrombotic medication.
Wasn't the study called Active-A or somethng similar?

[kenkeith]

My point is the government is conducting a study regarding the risks associated with PCI and A-fib and provide guidelines.  To read the response   "Due to your a-fib, even though controlled, they may decide to stent the culprit to prevent further problems...." is unclear whether or not there are now guidelines.  The quote suggests to go with PCI before confirmation of effective antithrombotic regimen!  It is not the A-fib under control that is the issue, it is control of the antithrombotic medication.

[ed34]

My information is from speaking to a patient who was waiting for a stenting procedure the same time as me. He suffered A-Fib which was controlled with medication and he was on Aspirin and Plavix for this. He was suffering Angina and said the cardiologist was concerned because the blockage was severe, greatly increasing his chance of a stroke with the A-Fib. He had the stenting done with no problem, and they made no changes to his medication. I didn't realise that aspirin and plavix was given as a combination to lower the risk of clotting from A-Fib. However, that is a research college and they seem to do things a bit different there. It is in that exact college "imperial college london" where they recently discovered a group of 30 genes associated with obesity. So maybe obesity isn't always associated with diet after all, now it looks like it can also be inherited.

[kenkeith]

Quote: "Due to your a-fib, even though controlled, they may decide to stent the culprit to prevent further problems. Your cardiologist will make the right decision".

Do you have more information related to the subject of A-fib and PCI?  The information I have is as follows and possibly PCI is contra-indicated and there are no guidelines by cardiac associations..

______________________________________

My understanding treatment of patients suffering from atrial fibrillation pose problems when percutaneous coronary intervention with stent implantation is performed. In the absence of solid evidence-based data, no definite recommendations for the management of this patient subset are currently given in the guidelines on percutaneous coronary intervention issued by the most prominent Cardiology Associations. The management of the antithrombotic treatment before invasive cardiac procedures is also incompletely defined. In this study we aim to determine in patients with atrial fibrillation undergoing PCI-stent. Not any conclusions at the present time.
1.the contemporary antithrombotic management;
2.the relative safety and efficacy of the various post-PCI antithrombotic regimens;
3.the safety and efficacy of drug-eluting stents (DES), bare-metal stents (BMS), and bioactive stents (BAS);
4.the safety of various periprocedural antithrombotic strategies including glycoprotein IIb/IIIa inhibitors and bivalirudin;
5.safety and efficacy of radial vs femoral approach.

I have a totally blocked LAD coronary artery (developed collateral bypass vasculation) and a circumflex artery 72% blocked.  I have been on medication to dilate vessels for going on 6 years without any problems.  

The guidelines by American Association of Cardiology and The American Hospital Association are to not treat with stents, blockages less than 70%.  First treat with medication to control symptoms, if heart related symptoms continue, then a PCI with stent (s).  If occluded locations are not suitable to stent, and/or size of lesion prohibits stenting, etc. then a bypass is the option. All three options are therapy for symptoms not a cure.  Other posts on this thread have given good advice to prevent any progression of blocked coronary arteries.

Hope this helps give you a perspective and information that will help you to ask the right questions when you consult with a cardiologist.

[bbuster]

I will keep you informed. These guys are top-notch and he is not even remotely concerned and advises nothing in the way of an angiogram. I was looking on the net, and I have read repeatedly that women have a 25% false positive with nuclear testing. what's this all about? Again, thank you for your kind and quick response

[ed34]

Will you please keep us informed. It is unusual for a cardiologist to notice if the image has a problem through tissue density etc. They view a lot of scans each day.
Even a small to medium artery can cause ischaemia. I'm not saying he is wrong, it would be great if he is correct but it does make one question the accuracy of cardiologists studying the results of  a perfusion scan.

many thanks

[bbuster]

I am friends with one of the cardiologists in the group, and he asked my doc to give me a call, which he did. He explained to me that is was breast tissue obscuring the scan and he is confident that is the explanation. He said there was no artery, only a small blood vessal occluded in the image. I am going in next week for a further review of the report, but he is not concerned. Thanks for your prompt and thoughtful replies - jeez!!

[erijon]

Ed is correct, but this should also be an "eye opener" for you. Please make sure to modify any risk factors that you control to keep any blockages in check. Smoking, Weight, Blood Pressure and Cholesterol levels are all something you can manage. A little exercise daily goes a long ways as well.

Good luck!

Jon

[ed34]

Mild to moderate could equate to any blockage that is between 10-69% because 70% and above is seen as severe. Mild to moderate would very likely be fine with medication but due to your A-fib problem, they may decide to stent it, to prevent further problems.

Mild to moderate is not serious and so don't get overly anxious about it. Your perfusion scan has simply revealed a lower supply of blood to a section of heart muscle. The defecit is not enough to cause irreversible muscle damage.

To really have a complete picture, an angiogram should ideally be performed, to have a picture of the inside of the culprit artery. It could be one blockage, or several blockages. With this detailed information, the cardiologist can decide the best treatment. Due to your a-fib, even though controlled, they may decide to stent the culprit to prevent further problems. Your cardiologist will make the right decision.