The Doctor wants to have a CT scan or angiogram taken of the coronary arteries to see exactly where the blockages are, and how large. From the results shown in those images, he will be able to decide on the best options for your husband. Once he knows the severity of the situation, he will be able to decide the best option by laying risk against benefit. For example, he may decide to continue with medication. Otherwise he will look at the possibility of using angioplasty (Stenting the blockages) which is less invasive than bypass. They will look at bypass as a last option because a triple has already been performed. It could be that one of the veins used in the bypass surgery has closed up, which is not exactly uncommon. It is all guess work really until the images are taken.
I thought I had better add this, in case you are unsure what a CT scan or angiogram involves. A CT scan is totally uninvasive, a radioactive dye is slowly pumped into the blood stream while the patient lays on a bed, with a circular scanner around the chest. Nothing touches the body, and you hear the operator through a loudspeaker in the scanner. They ask you to hold your breath for a few seconds now and again while certain images are taken. The dye can make you feel very warm inside, but it's rather comforting, nothing scary.
An angiogram is very much different, but again painless. The patient lays on a bed with a small scanner above the chest. This is operated by a radiographer who sits at the end of the bed. They also control the amount of dye and the type. The Cardiologist informs the Nurse how much relaxant to give the patient, and what mixture. You are supposed to stay awake but I keep nodding off with those meds. A local anaesthetic is applied to the inside of the right thign, just below the groin where a very small incision is made to access the femoral artery. The incision is only about 5-6mm long. I've had lots of these and wait for a pain or stinging sensation but have always been surprised to feel nothing at all. The Cardiologist uses the femoral artery to travel up to the heart, guiding his catheter. Once in the Aorta (large artery connected to output of left side of heart), he can go either into the left side of the coronary arteries, or the right. He will do both, but in no particular order. Once just inside, he will squirt some dye through the catheter to show up the artery. Your husband will be able to observe all this on a monitor above him. This will show where any blockages exist. The images are stored on a computer and the catheter is removed. The artery is sealed with a substance that dissolves slowly over 90 days. You have to lay flat for 30 mins, then get tilted slightly for another 30 mins, then you can sit upright for another 30mins. If no bleeding occurs, you can go home.
To be more helpful one should know the present condition of your husband's heart's ability to pump an adequate amount of blood with each heartbeat. The test appropriate for evaluation of pumping ability would be to analyze the degree of heart wall movement impairment from thd prior heart attack. Apparently, the stress stress was a perfusion test to view the blood flow at rest and during exercise. With exercise there is a higher demand for blood/oxygen and the test results would help determine the degree of blockage, etc.
The value of stress tests has always been recognized as limited in assessing heart disease such as atherosclerosis, a condition which mainly produces wall thickening and enlargement of the arteries. This is because the stress test compares the patient's coronary blood flow status before and after exercise and is suitable to detecting specific areas of ischemia (lack of adequate blood flow) and lumen (vessel chamber) narrowing, not a generalized arterial thickening or heart muscle impairment.
Cardiovascular magnetic resonance imaging (CMRI) is an increasingly available diagnostic method. It uses powerful magnets to look inside the body. Computer-generated pictures can show the heart muscle, identify damage from a heart attack, diagnose certain congenital cardiovascular defects and evaluate disease of larger blood vessels such as the aorta. It's non-ionizing and has no known biological hazards.
Your husband's cardiologist may be considering an MRI (magnetic resonance imaging). if not, and the equipment is available that is the best way with the least inconvenience. MRI can produce high-resolution images of the heart's chambers and large vessels without the need for CONTRAST agents, it's intrinsically three-dimensional, it produces images of cardiovascular structures without interference from adjacent bone or air, etc. A ct scan angiogram exposes one to radiation and contrast dye, and for a younger individual ct scan angiogram is usually contraindicated (<50 or so) unless there are special circumstances..
Years, ago I had had a heart attack and heart cell damage, but an echo (ultra sound)provided the necessary information. It is unusual to go to an imaging (ct scan, MRI or an invasive cath angiogram) without an echocardiogram!? Did your husband's doctor provide any information why an echo was not given, or was the test already given? Does you husband have heart related symptoms such as chest pain, shortness of breath....Those symptoms, or no symptoms may be a guide to the best treatment for your husband.
Thanks for sharing your husband's experience, and I hope I have provided some insight into what is involved. If you have any follow up questions, you are welcome to respond. I was you and your husband well going forward.
thank yall so much , as you can guess im a little worried , he has already had heart surgery and that was agony for me and him , then the heart attack , he has bad cholesterol and triglycerides it comes from his family , he has just turned 50 and we have a 14 year old son and our daughter turned 22 today , and he takes all news as bad news , after the heart surgery he started having anxiety attacks , and i know he's worried to and wont admit it . i just wanted to know what to expect , we'll know more Wednesday when we see the doctor as to what is going on and what he plans to do . i let everyone know how it goes . again thanks so much for your input ill be posting again soon .
thanks so much alabamataz