I am a 64 year old male who had an MI in November 2017. Holter monitor showed 75 Pacs in 48 hours. LAD : 90% at osteo prosemal part To have 40%. Sir Any info or thoughts you can give me would help. Your cardiologist has determined the blockages to be significant but not critical so the chance of a heart attack isnt a concern for him/her. you can follow my twitter at @MustafaAhmedMD, In a 100 percent occlusion ..developed heart failure symptoms The medication will likely be lifelong and can help stabilize the disease. You are already doing what needs to be done. You have LV dysfunction that is mild and no significant obstructive coronary artery disease. Major OM has critical proximal lesion. ki hum ko bipass karvane chia ja medicine lane chaiye. There is no evidence of stenosis or plaque. This is an amazing article. We are bit concerned with the following: an open bypass is clearly a riskier surgery than a stent. Since that procedure she has suffered no chest pains whatsoever. Im a 53 year old male and In August 2016 I had a TIA and since then I have seen several doctors trying to find the source of the problem. My cardiologist and a heart surgeon want me to have the triple bypass surgery. * mid Right Coronory artery 90% ( had stent placed) The above was really wonderful article. LIMA > distal LAD graft with normal anastamotic site and good contrast If further tests are performed such as a pressure wire or a stress test demonstrate that there is a significant related reduction in blood flow then a stent may be required. My ldl was 138 in October 2014. This is the same case as one of my friends . Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Tome me my EF is around 35 % ( they guestimayed) He is not physically fit and was found to have 90% blocks in 6 different places. Hi, dr mustafa Ahmed. He is still in CCU. Our sons are seeing all of this and are worried sick Bypass can certainly be done twice if needed. i can,t afford this treatment sir . In many cases such people need revascularization through surgery or stents in some cases. His blood pressure remained around 80/175 even with blood thinner medicine and he also on insulin. Usually, heart blockage in the moderate range does not cause significant limitation to blood flow and so does not cause symptoms. My father is on medication with 80 % blockage from 2012 and is doing fine. In addition to that hernia in esophagus was also diagnosed. Its not possible to give a specific recommendation without being involved in the case, knowing the history or seeing the images.If there is stable disease to the RCA that does not have high risk features then a trial at medical therapy is certainly warranted whether stenting is performed or not. If unstable i.e ongoing unstable symptoms etc then the answer is something likely needs doing, that can be determined by the treating cardiologist. Privacy Policy. But doctors also corealte the symptoms of hernia with heart. Its great to know the article helped. Does that usually mean a bypass surgery The symptoms are concerning. If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD. What other treatment may be possible? My father(72 age) undergone for CT Scan, Calcium Score was 393. Its hard to answer without knowledge of the artery or without seeing the films. I have stopped smoking and watching my Sir My father is 52 years old he has the history of hypertension, diabetes and asthama recently he was hospitalized and was diagnosed as Thanks so much! Pls ignore. Right coronary (artery) totally occluded with evidence of left-to-right collaterals. Thank you again. But mean while, is there anything I can do to help him? Cholesterol is normal, no diabetes, BP is within limits. Acuity of symptoms, risk profile and others. DONE MY PTCA. Findings were mild to moderate ischemia in Mid Inferior, Basal Inferolateral, and Mid Inferolateral regions. Can I continue with collateral vessels for a long time and if I maintain a good diet and exercise can collateral vessels maintain the needed blood flow to the heart in the future, Thank you in advance. I want to know that the recent ECG was taken by the lab when viewed by a cardiologist he suspected that there was an MI (heart attack) earlier. Did you have any form of stress testing? Knew something wasnt right 9 days ago. N test positive to heart attack. She has diabetes and high blood pressure ,doctor advised her do bipass surgery . Please let me know weather we requires stants plant or not. Dear Dr. Mustafa Ahmed, proximal segment of the LAD without evidence of calcified So, which test should I do to clear that this is not heart related ? Gets me scared because every time I look for info it comes up bypass..I am a whimp to pain so it stands to reason I am not wanting to hear this. His Blood pump is 55. OM1-80% stenosis (less than 2mm vessel), RCA : Co-Dominant. This was ignored by my cardiologist and I was dismissed. Does my condition require bypass surgery or can be treated with medicines. what was the cause for severe pain that the patient cannot tolerate? I dont have diabetes, quit smoking 2 years ago, and I am overweight. Patient still has heavy pain and freezing feeling on hand.He is trotally scared also. If your disease is truly stable then there is likely no urgency. What percentage is the blockage. According to the notes from my angioplasty my RCA was 95% blocked and I had a TIMI flow of 3. D1 : CUT OFF The LAD is not commented on and would be important also. It sounds like medical therapy has been advised as opposed to intervention due to the nature and location of the disease. My father 66yrs old had symptoms of dyspnea when walking,no chest pain. showed us a picture of the heart indicating where the blockages were I stage procedures commonly, whereby i will fix one artery in an emergency then bring someone back to finish the job. He already has stents from a few years ago and now 3 blockages again. the damaged area significant Ltd company of consulting Engineers and attending office regularly for at least 8-Hrs a day and facing all the day to day hurdles ,Tension etc. do you mean left main or the LAD? LAD 08 The good news is that his tests with regard to his heart appear to be ok. The artery running through the muscle is known as muscle bridging and in general is not considered to be dangerous, and it seems that it was not bought up as a cause for concern after the angiogram. there is lot of supplement for heart if those products have a true benefit which ingredient you recommend ? Subsequent angiogram revealed LMCA normal, mid LAD 80-90% stenosis, LCX non-dominant proximal LCX 30-40% stenosis, distal LCS 40-50% stenosis, RCA dominant, mid RCA 95% discrete stenosis, distal RCA has tandem lesions of 50-60% stenosis followed by 50-60% stenosis. In some cases multiple stents are required simply because the extent of the disease is so large, its not ideal but can be needed. Angiography was perfromed as the folllwing comments Right Cornary : Non-dominant vessel normal Im not obese, 50 years old woman. My Father had a heart attack which led to finding out that he has to 100% Blockages in each RCA, Circumflex & LAD. As can be seen in the picture above, there is a 100% blockage at the beginning of the right coronary artery stopping blood flowing any further and, of course, leading to a heart attack. Thanks Dr Ahmed was also asked by a gp to take sera flow 250(inhaler) for maybe asthma My cholesterol is very good now: total is 120, LDL is 37, HDL is 56. But now 5 years later Im still wondering if there should have been some treatment for this. I am experiencing fatigue. Jim. Thank you. It depends on the appearance on the angiogram. cardiologist advised viability scan. The one on the right is known as the right coronary. And after how longer the blckage again grow after angioplasty? USG whole abdomen report: Grade 1 fatty changes in liver Could you please advise if medication can help or angioplasty is required. Sompraz D Prior to your reply, I finally had a clinical discussion with my cardiologist about his angiogram report. Doctor suggests stent placement in the LAD after CTA. Was the situation stable? I exercise everyday and was even exercising when I was diagnosed with the RCA blockage. He had angioplasty 2 years back in right artery after the heart attack. Would it be ok for Amy to contact you?? Normal enhancement of the myocardium and endocardium. Im 28yrs old. Both parents have heart disease also. With regards to the 100% blockage, it depends on how long it has been there and whether the heart has developed natural bypasses known as collaterals. I found your illustrations extremely helpful and am able to understand more clearly the situation my mother is in thanks to this helpful website . Please I want to know your opinion to take the Best desition. How I can reverse it ? If you were my patient in clinic and were having chest pains and that kind of ct scan then i would probably consider angiography to see directly the degree of the narrowing. Ecg was not proper they said Do I try some life changing activities in diet or if that main artery is blocked, accept its a matter of time. But kindly advice us whether we have to go for open heart or angioplasty. As per the report. He is in ICU with my Niece frightened not knowing what to expect. They are at Centennial in Nashville. If they go through the groin area, which side will they go through? My father age 65 was suffering from atrial flutter. I suspect your arteries werent entirely normal prior as they are unlikely to have been so quick to develop an abnormality. below is the report. I have no pain at all. My husband of 45 had bloods X-ray echo scan x ray stress running machine test and the test that puts dye through his veins and checks the heart all fine Urging us to quickly progress with the decision. Please advise. CABG is the final solution? Thats not really possible. As for future stents or bypass i really would need to see the films to answer. In June 2014 at 50 with no warning signs other than elevated cholesterol, I had a heart attack in the inferior with 3 blockages on right side treated with 2 stents and 2 narrowing on left treated with 2 stents. Women have no say about what I eat and they never cook or prepare anything for me. Thanks for your reply, the Main results of the stress test are: -Ischemic changes of reperfusion without symptoms are shown. Proximal LAD shows calcific plaques with segmental moderate stenosis. He said he also wanted to put him on blood thinners, but needed to know what the vascular surgeon was going to do about the aneurysm and was also going to contact him. No chest pain, no shortness of breath etc. My wife is 88, and suffered a heart attack; as a result 2 stents were placed. What is the problem? How to rule one of these two out to start focusing on the right treatment. Its difficult to be able to provide any form of comment without seeing the images themselves. A heart team approach is key and also ensuring the disease is severe enough to warrant treatment in the first place as opposed to medical therapy. PLAN : TO BE DISCUSSED. There is no evidence of plaque stenosis. The hospital sent him home and said they could not do anything to him as his heart is too week . If you are interested in cutting edge information and therapy for heart disease then follow our twitter at @MustafaAhmedMD. Spasm can cause angina in certain cases and there is treatment for this such as calcium channel blockers and nitrates. Got the CT coronary angiography test done for him and below are the findings. In 2014 I had a non stem MI and sent home with meds whilst tests were done. Ejection fraction: 64% Cardiologist office She is sending me for my 3rd Stress test, I have a 100% Blockage (maximum of 60 70%) with focal area of near total occlusion. My family has history of heart disease. In general single vessel disease well managed on medicine does not necessarily need any intervention. Dr. Ahmed This entails the things you already seem to be doing and will act to be the best way we have of stabilizing the disease and improving your long term outcome. I told the nurse to tell the Doctor of this possible delay. I guess its the left main as listed by the report, Left main coronary artery has a 60-70% distal stenosis and bifurcates into the left anterior descending artery and left circumflex artery. taking choplodogrel/clopilet 75 Hello Doctor, shes got blockages in her other arteries that they say medicine will fix but right now. It really depends on the complexity of the disease. It may be worth defining the anatomy with catheterization to ensure there are no critical lesions underlying. Req No : 8482 walking normally was 80 or so, now at times 95 to 120 on afew occasions He said because of a tricky turn he did not try to insert a stent and we have been trying medication. dont take chol lowering drugs as side effects was huge pain all over, etc Whether 100% block can be opened with stent and what is the success rate. * LIMA > distal LAD graft with normal anastamotic site and good contrast Sorry you are having such a difficult time, with this the recovery may be long, so try be patient although i know its difficult and ask the team there for more in depth explanations with regard to the above. -ST Depression on DII, DIII, and aVF, V3 and V4. Patient Name: Mr. D S S SANKARA RAO *The mid left anterior descending coronoray artery has 80% stenosis, invoolving the origin of the second diagonal artery. No pericardial effusion, intracardiac mass, thrombi or vegetatian seen. Also plz answer BACK OF HEART- LOWER CHANBERS. Its not really possible to comment without seeing the films. 3. Is that significant? I am a runner(was until the chest pain got too bad to continue). These include vessel size, area supplied, area at risk, symptoms despite medicines and other factors such as procedural risk. June 8, 2014 by Dr. Mustafa Ahmed 594 Comments. My dad have three block age what to do bypass surgery or some medicine, Sir my father had a heart attack 1 year ago from nw, n doctor suggested for cabg bt my father is very afraid to do so, sir plz do rly me as soon as possible, its very severe,, sir my watsapp is +918240071371 n Im frm India,, plz do rly sir. PDA & PLV : 70-80% at PDA. My angiography found the RCA subtotal occlusion (SCO) in the middle vessel..and the Dr said that the stent could not be entering the blockage since the occlusion is hard to be inserted by the wire. Impression: Distal = Normal I am doing fairly well now on meds but experience occasional mild angina with moderate exercise. This is very helpful. Can i handle this situation with medicines. Echo normal, normal LV systolic function, PDA diffuse plaquing and PLV plaquing. Im almost 48 years now. Cordarone X 200mg Daily twice Her sugar level reduced abruptly to 152 from 260. Are there any other significant blockages that require treatment? Treatment for this ASAP. Rest of the LAD appears normal. Mid & Distal = Diffuse Disease 70% (Suggested conventional coronary angiography for further evaluation.). I recently was released from hospital with 2 stents put into LAD(80%) and LCA(90%). I was lucky that they used my arm for it. I am in need of an honest opinion PLEASE.52 year old male. On July 14, 2016 his CT angiography was done and if required I will send images to you. first marginal branch occluded Doctor said to do ptca with stent to om1 What may be the issue and possible treatment? A lot of factors are included in the decision including how stable the patient is and how stable the blockage is. Hi. In this case, surgery will likely be recommended. I want to discuss my fathers heart disease. I am 39 years old, male,. thank you I just had a stent in LAD and I have 3 more 50% 60% blocked now I am worried they will get worst .. Dear Dr, Please help. Also, such a case needs to be done by an experienced operator with adequate back up and equipment for a case of this complexity. Now let me know plz how much is this critical blockage in %. Also, the older blood vessels had settled on the heart and how do you ensure that bypass graft sits on the heart all along? Thank you so much for this website! While on the procedure patient suffered with severe pain on arm and only one stent put on 95% block portion. Moderate atherosclerotic calcified plaque identified within the Left circumflex artery (LCX): my father 65% blockage in right side . The anterior wall appears to be more hypokinetic than other subsegments. three vessel CAD with severe high grade proximal stenosis in the ostium of the LAD and a subtotally occluded circumflex system. Marginals- Major OM plaquing. INDICATION: ACS-Ev,AWMI, LVEF-46%. Approximately, 4 blocks were found and were removed successfully. Eptus 25mg They told me I have 2 weeks to get a 2nd opinion. I was a regular smoker for 20-25 yrs(since stopped),Diabetes level 2,since5-years (continuing to be on Glyree 1) ,Hypertension -15years (continuing to be on Tenoramin-50 & Pinom H ).Till to day I did never had any angina /shortness in breathing except occasional tiredness and in regard to food habit I am always a small eater with very moderate life style. Needless to say I am somewhat nervous. I feel I can still run like a child and after running I feel so great. I would need to see the films and understand the situation better to comment. 1. The words occluded may well be referring to balloon wedge occlusion which is a normal part of the test. Found that 2 arteries were blocked! The 40% blockage in itself doesnt signify you will have a heart attack, rather it demonstrated the presence of a disease process. OM3 : Normal in calibre. i can,t feel any pain . doctor is telling that as its a small caliber vessel stent is not required only medicine will help. and also to stabilize disease (medications and the things mentioned before). 1. one thing plz mension sir . Im suspect that the vessel may have closed down and therefore a heart attack occurred and the muscle may have already died which would mean opening it back up at this stage may not help. I just found out that my mother she is 73 has 100% blockage in her Right Artery, and was told that the left artery compensated for the blockage. Its diagonal (D1, D2) and septal branches are showing normal contrast opacification. Apparently she was able to walk on the treadmill for only 3-1/2 minutes during the stress test and they didnt proceed to the second/chemical part of the test. i mean is it possible that its mentioned as 30% in my case whereas in actual it might be 70% coz of the MB ? Do you think it is necessary that i have the stenting done? RCA and LCX Territory: Lateral and inferior walls are perfused at rest. Another question cant a stint be put in the 100% one as well to get the blood flowing again? last 4 years was on a diet where I ate balanced through out the day, though for dinner would eat 150 grams of cottage cheese + tomatos + pulses The cardio CT scan I said in my initial input that I had passed in flying colors last Dec. was not a cardio CT scan, but rather it was a cardio PET scan which showed blood flow rather than occlusions. How the situation happened? Hi Dr, Thank you so much this brilliantly written article. Sir my mother has LCx 99% stenosis OM2 normal om3 small i read about spasm in heart tiny vessels and it make chest pain like angina , is this true ? I have PVCs and none of the meds work. However, CT Angiogram results came as follows:- That is excellent and actually more reassuring. LAD (Stented)-highly suspicious for severe restenosis Please share your valuable advise. 8. I know doctors are very busy saving lives however i feel abandoned without more info like will I be a possible condidate for Bypass surgery in the future or will I need stents.