At MyHeart.net, we’ve helped millions of people through our articles and answers. Now our authors are keeping readers up to date with cutting edge heart disease information through twitter. Follow Dr Ahmed on Twitter @MustafaAhmedMD.
Heart blockage is a term commonly used by patients referring to coronary artery disease, a build-up of plaque causing narrowing of the arteries that supply the heart muscle with blood. This heart blockage, if severe enough, can prevent the muscle from getting the blood it needs to function, especially at times when more blood flow is required such as when exercising. This leads to symptoms such as chest pain and shortness of breath.
Various tests can be used to see if there are areas of the heart that have compromised blood flow, such as exercise stress tests and nuclear scans. These tests are not perfect, however, and in patients determined to be at significant risk, the standard way to directly assess the heart blockage is to look at the outline of the actual vessel itself with a procedure called a coronary angiogram, as seen in the pictures below.
Heart Blockage – Normal Coronary Arteries
There are three arteries that run over the surface of the heart and supply it with blood (see the diagram above). There is one artery on the right side, and two arteries on the left side. The one on the right is known as the right coronary. On the left side, which is the main side, we have the left anterior descending (LAD) that runs down the front of the heart and supplies the front and main wall, and then the left circumflex that supplies the sidewall. If you look carefully, a major artery called the left main artery supplies the LAD and the circumflex. The left main artery and even the LAD artery are so important that critical blockages in these arteries are known as the Widow Maker!
The picture above shows what we call angiographically normal coronary arteries. The artery appears smooth with no irregularity. The reason we call it that is that although it looks normal by angiogram, and there is clearly no significant heart blockage, there may be deposition of plaque in the walls of the artery that can’t be seen on this test. That can still progress over time, and it’s why patients at risk of coronary artery disease should still pay close attention to minimizing the risk factors for this despite no visual heart blockage and an apparently “normal” angiogram.
Heart Blockage – Mild Coronary Artery Disease
The diagram above shows an artery with some blockages that are in the 20-40% range. Typically, we call heart blockage less than 40% mild. Such blockages are clearly not causing restriction to blood flow and therefore very unlikely to be causing symptoms. It is important to note, however, that there is clear evidence here of progressive coronary artery disease and such patients need aggressive attention paid to risk factors for coronary disease (cholesterol, diabetes, smoking, blood pressure etc.), appropriate medicines, and healthy lifestyle changes such as exercise, weight loss and dietary modification. Paying close attention to these things can prevent progression of heart blockage and help to stabilize it. Don’t forget, it is often the mild heart blockage that can become unstable and burst, leading to a heart attack.
Heart Blockage – Moderate Coronary Artery Disease
A moderate amount of heart blockage is typically that in the 40-70% range, as seen in the diagram above where there is a 50% blockage at the beginning of the right coronary artery. Usually, heart blockage in the moderate range does not cause significant limitation to blood flow and so does not cause symptoms. Moderate coronary artery disease is treated much in the same way as mild disease, basically attention to risk factors, medications, and healthy lifestyle modification. Occasionally, heart blockage at the higher end of the moderate range (50-70%) may require additional testing to see if it is significant or not and may be responsible for symptoms.
Heart Blockage – Severe Coronary Artery Disease
Severe heart blockage is typically that in the greater than 70% range. This degree of narrowing is associated with significantly reduced blood flow to the heart muscle and can underlie symptoms such as chest pain and shortness of breath. In the diagram above, an 80% blockage can be seen at the beginning of the vessel. This is actually a bypass graft in someone that has had bypass surgery. The severe heart blockage caused symptoms and was treated with placement of a stent as can be seen in the picture. Sometimes, bypass surgery is required in the setting of multiple severe blockages.
Heart Blockage – Totally Occluded Artery, Big Heart Attack!
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. Such a heart blockage is typically accompanied by major symptoms, and treatment needs to be given in a very timely manner. As can be seen in the picture, this artery was treated with stent placement to allow normal blood flow to resume. If the treatment for this isn’t done within good time (usually the first few hours, the sooner the better), then the heart muscle may die, and once dead, cannot usually recover, which results in reduced heart pumping function and heart failure.
At MyHeart.net, we’ve helped millions of people through our articles and answers. Now our authors are keeping readers up to date with essential information through twitter. Follow Dr Ahmed on Twitter @MustafaAhmedMD.
Other posts you will like
Mahalo for sharing these imagines, they helped me understand my mothers diagnoses. I appreciate your effort and simplicity!
Laurie
Thanks Laurie. It’s great to know the article helped. If you have any specific questions feel free to ask them in the comments and I (or one of the other doctors) will try to respond as soon as possible.
This is very helpful. However, I have chest pain, burning around chest area and abdomen. Can’t run anymore, walking fast, I’m out of breath. Walking up the steps is a job as I’m out of breath. I’m not obese, 50 years old woman. What is the problem?
I suggest you have your symptoms checked out. I would recommend you see a general Dr and see if referral to a specialist or further testing is required. It could be a number of things, or simply getting less fit. Best to get it checked out.
Dr. Ahmed, I just got out of hospital 3 days ago and had a nuclear stress test which revealed a blockage. To look further the cardiologist performed a catherization, which he then informed me I had av50% blockage, but did not put a stent in, is this normal procedure?
Hi Cheryl, the stress test is suggestive but not always confirmatory. The cath was more specific and showed a 50% blockage. Unless > 70% a stent would not typically be of any use, in fact can be more harmful. Medicines are your best option at this point.
9sir i am 24 from kashmir sir actually from last on3 month my bp remains high 150 /90… 160 …90
I am feeling in centre chest pain also ..i have done all my tests with like sugar test blood test urine tes ..urinary vma ..ecg ultra sound A to Z ….Reply me please on my email …
Hii doctor my age is 80 and I have 4 blockages 50% 70% and 80% 80% I am very lean and not so healthy person so far . Doctors are saying to take heart bypass surgery . But I think I will not survive in that . Please suggest what is best for me
I would need to see the films and know the clinical situation to even begin to discuss specifics. Every case is different. Did you seek a second opinion if you are unsure?
My mother has LMCA distal segment has 60% stenosis LAD type 3 vessel and proximal LAD has 70% stenosis ,D1(2.25mm)vessel and Ostial segment has 90% stenosis . LCX non dominant and proximal segment has 70% stenosis . RCA dominant and mid segment has 20% stenosis ….. is bypass surgery a must or any other alternative to it ? Thank you in advance
The need for treatment is determined by many factors – symptoms, heart function, and risk as determined by testing and history. If surgical / stent treatment is determined to be necessary then in this case bypass sounds like the most likely preferred option.
My dad have three block age what to do bypass surgery or some medicine
Do you have more details?
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, it’s very severe,, sir my watsapp is +918240071371 n I’m frm India,, plz do rly sir
I recently was released from hospital with 2 stents put into LAD(80%) and LCA(90%). Started out the day with stress test and was detained and admitted that day for the procedure. I went in for the reason others spoke of, fatigue or burning in chest, sometimes due to exertion sometimes no reason at all. I blew off the discomfort long enough and glad it wasn’t any longer. The procedure was NO Biggy! nothing to be scared of. Root Canals are worse!
My grandparent have 100% blocked LAD. He is on medication. No serious symptoms sometimes headache and insomnia only. Angioplasty required or not?
Good Afternoon,
Cardiologist office She is sending me for my 3rd Stress test, I have a 100% Blockage
in my Circumflex Right Coronary The right coronary artery has the stent, Is told that
I was told that i would bleed to death by the break up, And I would die. I value your comments on seeing the picture please let me know what do you think.
I am 58 Years old
De’ete Chano,
Maidin mhaith. Lo siento cariño, pero un Circumflex Coronaria Derecha no existe.
“Circumflex Right Coronary ” No such thing exists. Sorry and good luck.
~Sophia
Sir I have diagnosed with 50% blockage in proximal lad ,then also tested by ct angiography my calcium score is 24 , please tell me about further treatment, I am always worried about it
it very well can be a Blockage of your right main Artery of you Heart.get a Dye Test.
Stress test abnormal was told to have a heart cath done which is scheduled
Stress test showed blockage
In front of heart and heart only working at 50 %
Does that usually mean a bypass surgery
I know you can’t say fir sure
Thank you
Hi, I had an Acute MI treated with Stenting in LAD in OCt 2015.
I still feel heavy chest pain occasionally with headache, pain in section below my right Jaw and right arm around elbow and below it.
Is this a reflection of a 2nd myocardial infarction that I may suffer. Please suggest.
Just to share a fact that may help, my job keeps me tensed all day and I am a smoker too with an average of 5 sticks a day at least.
Please suggest
I suggest you see a specialist sooner rather than later. The symptoms are concerning.
Hi Dr Ahmed
I have a problem with posterior anomalous right aorta. I feel tired and chest pain when I try to walk on hilly upward road. What should I do if any suggestion.
Can you give more details, are you referring to the coronary?
hello sir the doctor that my dad has block im his heart
but we are unable to find out what percentage of block he has
can u please help us out to find the percentage of block
it would mean the world to us
Hey doctor I have blocked artery in left arm getting .I know I need bypass. Been waiting can that block blood flow to my brain
Ok say tthans to your comments
I have a stent in the rca i would like to know how thick my blood should be i do use blood thinners to prevent clots i am 37 years old
It depends when and where it was placed, I would make sure you call the office of the performing physician to clarify.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Had many test done 10 months ago my heart doctor said I good to go,3 wks.ago had open heart surgery and had to replace 4 vains from my leg.Could this have been prevented? Donald Worrell.
Testing when it comes to cardiac risk stratification is good however I’m not always perfect. It sounds like the disease was picked up ultimately and treated appropriately. It’s important now to consider lifestyle factors, treatment of risk factors and adherence to medication and follow-up. It’s not necessarily whether this could have been prevented, rather this disease process has been going on for years and years and finally got to the stage where it require treatment. The key now is to ensure disease stabilisation.
you can follow my twitter at @MustafaAhmedMD
In a 100 percent occlusion ..developed heart failure symptoms
stented LAD on day 8 post attack
Heart failure persisted post stenting
2 months later, needing ICD for ventricular ectopics
EF decreased to 21 percent.
the damaged area significant
hypokinetic and akinetic areas present
no significant risk factors.
mildly high cholesterol
is there any treatment for this condition?
already on anti failure medication
I have what the Doctor pictured, left 60% blockage in one area, and total blocked right side. After the test, my Cardiologist said I had a self intervention. My left side sent out 4 shoots to the right side and pumped blood through and I was fine. I wonder if it was to do with my walking up 9 flights on a regular basis, and I am a non smoker at age 74.
Is self intervention rare?
I suspect she/he was talking about collateral formation for chronic total occlusion, this can be common.
Please follow our Twitter at @MustafaAhmedMD
my father have small heart block and doctor said that it will be solve by eating medicine .Is that right please tell
I have a question. I had a tvra procedure done for my sevear aortic stenosis. During surgery it moved and i had to have a second valve put in because the first one moved. That first valve was placed in another part of my heart. I was told it was fine and would not cause a problem. I had this procedure done in a different state and was told i would always need to come there for treatment because no other cardiologist would know what to do. My concern is thats second valve that moved and just placed some where else in my heart. Will it cause me problems does it need to be removed?
Do you have further details of what happened? Valve type and final position of the embolized valve?
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Does anyone can say the % of ateri blocked without doing the engiograme ?
I cannot tell u how much these tutorials helped understand what is going on w/ a stent placement thank you so much.
I’m glad it helped. Although many people receive a stent, they often have no idea what it treated or why it was placed!
Hi,
My father is on medication with 80 % blockage from 2012 and is doing fine. Recently, he had an angiogram and we have come to know he has one 90 to 95 % block on right side and an another 80 % block on left. He has absolutely No Symptoms. Pls advice of a bypass is essential. He is 80 yrs now. PS : he has BP and diabetes but all under Very good Control.
What did you did then??…same problem with my grandmother please reply
Hi colleagues, how is the whole thing, and what you wish for to say
regarding this post, in my view its really amazing in support
of me.
great information ! 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,
my slef sumit upadhyay and one month before i got chest pain and heart attack my age is 28 and i done andiography in report i got 40% blockage please suggest what to do. And is there any big probleum.
dear sumit, this is mohammed mumtaz, i have 100% blockage, don’t worry you have only 40% stop eating oil ghee butter and animal food, 30 minutes walk and some yoga, and drink lounki juice every day in the morning within 6 month you will be alright,
take care have nice day,
Dear muhammad, same me here 100 % heart block , how does it help for treatment? How do you treat now?
Hi Dr , I’ve had 19 Stents, 2 different Open Hearts with Bypass x 3 each. I’m 56 yr.old white male. I was in the Intensive Care Until last week with sever Angina. My RCA Graph is 100% Occluded. LAD is feeding some of the Right,but mostly Collaterals I was told ” There’s Nothing we can do for you >??????? I’ve done EEPS . Is this True….just Death Awaits >?
I was told I have 95 percent blockage on left and right artery. Surgeon did Angioplasty but did not insert stem because the blockage each was about 3 inches long. I was told to be on change life style, vega diet and take blood pressure and cholesterol medications. It’s feel like a walking bomb. What other treatment may be possible?
Bypass surgery
If one valve is 60% and another 70% blocked then suggest the best way to clear it…
My husband is having same problem. He is 55 has had 2 bypasses x 4 with 39 stents some are gone from failed bi passes. Was also told nothing else we could do. We have gone to Cleveland clinic and are waiting on them to go through all of his med records to come up with a plan. They acted like they had ideas of what to do they were sending it to a doctor that does complicated cases. Let me know if you hear anything on your case
Hello Dr. Ahmed,
I want to say that this article is great. I am teaching senior nursing students and was wondering if I have your permission to use to your pictures and explanation in my lecture? Certainly, I will give you full credit for your work. Thank you in advance, Mary Brinker Ed.D (c), RN
Absolutely no problem. If you use the pictures and content online feel free to backlink also.
My friend died because of 100% blockage. They said they couldn’t put a stent in. Why was that?
My friend died because of 100% blockage. They said they couldn’t put a stint in. Why was that?
This is the same case as one of my friends . Financially cannot afford expensive treatments
Only 15 to 20 % heart is working
The doctor says that he cannot be operated and angioplasty cannot be done
So is there any other treatment where by his life is saved
Angeiogram revealed that I am having six blocks but I do not experience any problems othan that and nor do I feel. Is surgery yet essential
having 90%block in rt dominant coronory artery,no symptoms.no ecg changes.pl suggest treatment.
My dad is 57 years old and he just went and had several heart tests done. An when he went back to the doctor, doctor told him he had a 100% blockage and a 50% blockage but they wasnt worried until it got up to 70% blockage. So my question is why does the doctor want to wait til then if he could do something now? Another question cant a stint be put in the 100% one as well to get the blood flowing again? Thanks!!
Its often complicated but ill try give a simple answer. There is generally no benefit to treating a vessel that is not significantly diseased or compromising blood flow. Blood flow is generally reduced when the angiogram demonstrates a 70% or greater blockage, in fact that may be harmful. https://myheart.net/articles/stent-save-life/. When there is some ambiguity regarding the severity of a blockage further information is gathered using either a stress test or a pressure wire test. 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. Opening up a chronic 100% blockage is not a first line treatment, is a complex procedure, and generally medicines are tried first.
I have PVC’s and none of the meds work. My doctor says there is nothing he can do about PVC’s.. Is that correct? I feel like it controls my life now.
My mom is 72 and has 99℅ blockage. She is doin the stint procedure tom. Will she be okay
I hope things went well!
My mother was diagnosed with 60% block in the artery ( not in the main artery).
Does this require surgery , doctor has given medication for 15 days and have asked to come for pressure test.Please suggest.
Its hard to answer without knowledge of the artery or without seeing the films. In the case of a 60% blockage, often medical treatment only may be required. 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. https://myheart.net/articles/stent-save-life/
I am worried. I had a NONSTEMI on 9/4, stent placed in RCA. Was 95% occluded. Left is 100% occluded with collaterals present. I have an EF of 45. I am worried as my dr is tightlipped about my condition. Wont really say anything until Nuclear stress results come back. I am worried because the internet is a bad place to be if you are trying to find medical information. 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. Thanks for ANY info I can get.
It sounds like you have severe multi vessel coronary artery disease. I’m not sure if you have had bypass before, but if not it may well end up being the preferred option to restore blood flow to the heart.
I just had a stent inserted in my LAD artery this past Monday (10/26/15). It was 100% blocked! I think my heart Dr. knew the Friday prior that it was 100% blocked or at least severe! But, he scheduled the procedure for late the next Monday. Am I wrong in thinking the heart cath should have been performed immediately?
Timing of intervention varies greatly based on the clinical presentation. In cases where patients are clinically stable, there may be no advantage to proceeding immediately vs. waiting a short while. It depends on many things including EKG patterns, blood tests, blood pressure and so on. Hopefully you had a good outcome regardless.
My age is 61 and Till last year ( Feb 2014) medical checkup, I got OK as i COULD COMPLETE TREADMILL TEST PROPERLY. I have no history of heart trouble.
My question is – for a normal person, at the age of say 62, will there be zero blockage ( below 40%) , or with passage of time – age, the blockage can be occurring. What can be the safe limit of blockage for a 62 years man.
Hi Dr. Ahmed,
Nice site and Information.I have one query.
Doctor did Angioplasty and found 50 % Blockage , theysaid there is no need to do any ByPass.
They gave some medicine named as : Clopilet – A -150 ( conatins Aspirin 150 mg and Clopidogrel Bisulphate contains 75mg ) and told to continue.
Its is already been 2 years now since he had the Angioplasty .
What to do with 50 % Blockage , do we need to continue the medicine or do any kind of test to see the status of the heart ?
Good day and thank you for taking the time to answer people’s questions. I am in need of an honest opinion PLEASE.52 year old male. I had minor breathing difficulties and went to ER after my doctor’s recommendation. Stayed in hospital 5 days. Echo test findings: Study is technically difficult. There is mild concentric LVH. There is mild to moderate, diffuse left ventricular hypokinesia. The anterior wall appears to be more hypokinetic than other subsegments. No pericardial effusion, intracardiac mass, thrombi or vegetatian seen.
then next day hospital did angiogram.
cardiac doppler: a cardiac doppler was performed. this finds trivial aortic insuffieciency, mild mitral regurgitation, with decreased LV compliance.
cardiac cath 11/27/15
RA=15
PA=50/25
PCW=30
LVEF=305
LM: NORMAL
LAD: 90 % MID
LCX:80 % MID
RCA:99 % MID
IMPRESSION: 1. HTN with hepertensive HD disease
2. Dilated cardiomyopathy, acute systolic CHF, LVEF 30 % . Still with high very filling pressures.
3. 3 vessel CAD 4. Dilated aortic root
Cath shows poor EF with severe multivessel CAD. Tome me my EF is around 35 % ( they guestimayed)
Plan-
CV surgery consult for possible CABG to LAD, LCX, RCA
I told them I needed a 2nd opinion and left the hospital.I have been brisk walking daily for a mile and feel fine. They told me I have 2 weeks to get a 2nd opinion. I feel like my heart is a ticking time bomb. When they did all these tests on me are they able to see if collateral’s have formed or is that something they don’t look for? Am I in trouble?
Dear Dr Ahmed
Just want to mention I am 56 year old male and a chartered accountant in south Africa. my weight is about the same I do running twice a week on a saturday and sunday 30 minutes non-stop and a lot of walking during the week. I feel I can still run like a child and after running I feel so great. I don’t smoke don’t eat too much red meat and don’t touch cooldrinks maybe two glasses in a year.
Please tell all these people writing to you that exercise is the best to avoid heart problems and avoid smoking its a killer!
I think that’s excellent advice and something i tell every single one of my patients. Avoidance of smoking is key. Lifestyle is critical as it can prevent progression of disease.
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. Can they do bypass surgery? Thank you so much for this website!
Lisa
i just had 2 stents put in my heart,the doctor told me i need bypass, in the front of my heart.there is 3 blocks.60%any d 70% and 90 %. the stent doctor said it was to dangerous to put stents in and a need bypass.my question is why is it so dangerous to place stents in front of heart?
Its not that they are dangerous, its simply that in some circumstanced bypass gives the best results.
Hello Dr. Ahmed, I’m 36 yr old and suffered heart attack, diagnosis revealed 3 blocked arteries; LCA-70%, LED 90% & RCA 100%.
LCA & LED were stented but RCA is still 100% blocked.
There was viability scan done on my heart and it shows 15% viable myocardium so doctor advised me to get RCA stented. I took another opinion from senior doctor in Singapore and he advised me not to go ahead with stenting to RCA, he says there is more rick than benefit if I get CTO on RCA. How much is 15% viability in medical terms if its good should I go ahead get RCA opened ? Please advise.
This depends on a lot of factors. If the CTO is to be fixed you need to ensure you have a good indications. Simply the presence of a CTO isn’t a reason to fix it. In addition to the ischemia and viability it would depend on the presence of heart failure, heart muscle dysfunction and importantly symptoms. Once that has been determined the films would need to be reviewed. All CTO’s are not equal and some are riskier to fix than others, that should also eight in on the decision making. Its important to obtain an opinion from someone experienced in CTO’s to that regard.
Dr. my husband had stress test..and angiogram.that uncovered a L-35% & R80% blockage..he was told he was not a candidate for stents nor a bypass and nothing they can do,he had 2 opinions…why no bypass or stents?thank [email protected]
Dr. Mustafa,
Please explain to me the prognosis of a total occlusion of the Mid Right coronary Artery.
How critical is it to intervene and why type of intervention?
Thank you
This is a good question but it is complex and the management and prognosis of a mid RCA occlusion differs from patient to patient. It depends on a number of factors such as the area supplied, the dominance of the vessel, evidence of compromised blood supply, the extent to which the body has built its own biases called collaterals, the heart function, symptoms present, the anatomy, and also the state of the other vessels supplying the heart with blood. In many cases simply medical management is advised, in other cases intervention such as bypass or stenting is advised, however that depends on many of the factors as outlined above.
Hi sir…my mother has 60% blockage in one of the left arteries.medicine treatment is started. Please let me know weather we requires stants plant or not.
Hello, I am a 30 year old female with hereditary heart disease. In 2014 I had a non stem MI and sent home with meds whilst tests were done. angioplasty that was done in November 2014 showed totally occluded 100% blocked RCA and I was referred to another hospital due to current hospital not able to perform complex PCA. new hospital inserted 4 stents into my RCA in Jan 2015 and I felt better for the first month but soon began getting chest pain again. This was ignored by my cardiologist and I was dismissed. I had this until November just gone and ended up back in hospital where angiogram showed that the stents had failed and my RCA was 100% occluded again. First I was told. I would need a bypass but then re stenting was recommended and I had that done 2/12/15 with an extra stent inserted. I had continued chest pain on my return to home and have since been told my LAD is showing 60% and 40% blockage and I’m waiting for a pressure test. I am so scared and tired of worrying about every niggle and strange feeling I have and just wish I could get sorted once and for all. No answers to my question as to why my artery totally re blocked even though I take my meds including clopidgral, rosuvastatin 40mg and Ezetimibe 10mg and yet they don’t seem to be controlling anything and i am concernedthat by the time anything is done ie tests my LAD will be 100% blocked. Was told in April last year that all my arteries other than my RCA were perfect so the 40% and 60% blockage to LAD has happened within months. What can I do to get my life back and feel well again and also rid myself of this fear and anxiety whilst awaiting for Drs to do something about it. Not got much faith since I seem to be overlooked a lot and not listened to due to being young and it’s only ever urgent when they actually are inside my heart and see themselves what they’re dealing with. Any advice would be appreciated, thank you and Happy New Year also x
You have a very aggressive form of coronary disease and you seem to be on an appropriate medication regimen. I suspect your arteries weren’t entirely normal prior as they are unlikely to have been so quick to develop an abnormality. I think review of your prior films would show they were likely abnormal before. In terms of bypass, the pressure test will tell us the significance of the LAD disease, and if that is significant, from what you have described bypass would certainly be the preferred option although i can’t be specific having nor seen you or your films. I realize you must be very anxious and I think its reasonable to tell your heart Dr that and ask to be expedited due to that fact.
Thank you, really helped me to understand what the nurse told me when this happened to my father-in-law. It was reassuring to know what was going on!
sir,
one of my family member , female (around 60yrs), suffering from diabetes & blood pressure is suffering from high BP now a days. after some tests doctors suspected heart blockage. and suggested angiography. please help me in guiding what exactly it is and what possible efforts can we do & what can be further complications.
it would be a great help to me.
thank you
regard,
palak
I have a 30-40% narrowing of the mid LAD what does this mean? I also have MVP with Reg and Tricuspid with Reg both mild.
That means that you have some narrowing in your artery and therefore coronary artery disease. The degree of blockage is not likely to cause symptoms or a major problem as it is less than the 70% range. Since you have the evidence of coronary disease though you should take care to address risk factors to prevent worsening of disease (prevent and control diabetes, stop smoking, cholesterol, diet, exercise, lifestyle, blood pressure etc.) and also to stabilize disease (medications and the things mentioned before). Your valve disease is not of any significance so don’t worry.
Sir please reply to my post below.
– Rajendra Dhanayat
dr pls help mu father 61 yrs old is has gone for angiography last week and is diagnosed by 3 blocks 70 percent dr suggested to go for the biapass surgery, but my father is not prepared for the surgery he want to wait for 3 mths. plssssss suggest can we wait for few mths .Awaiting reply
my mother sufferd heart attack and was advised angiography which showed rca 100% blocked. cardiologist advised viability scan. prior to ptca. would like to hear your views on it.
If patient has 3 blocks ranging between 90-99% then bypass surgery is the only option or any other alternatives are available?? Please reply asap
Depends on many factors and would need to see the films to be honest. In most similar cases, if possible, bypass would be typical.
Father, 94 with diabetes (otherwise healthy and fit) had heart attack and catheterization showed three blockages 99, 90, and 70%. Options last night were bypass ir medications per cardiologist. We opted for medications. But today, his long-term primary care physician said medications won’t do much of anything and offered one stent as an option. Father has a DNR, declines dialysis, cancer treatments, etc should he need those. I’m wondering if having a stent put in, at his age, is worth the risk. What medications would be optimal? If this were the extent of the information you had, what would you choose if you were the patient? He hasn’t been doing much other than watching TV, and hasn’t been going out if the house for several years. He has been doing stairs to get to the bathroom. I would really appreciate your opinion on treatment and specific medications. Should meds be used prior to steering?
It’s a well written article. Thanks doctor. Your non-technical style of explaining a highly complex issue to layman audience is fantastic.
Hello Doctor ,
My father had and heart attack 15 days back he was found to have TVD on angography EF – 25-30%
CAG – LAD distal 100%, Term OM – 100%, RCA Prox 100%, POBA was done .
patient is suffering from diabetes as well . patient is a case of DM/HTN/ COPD.
As per the doctors bypass surgery cant be done at all , could you please suggest. awaiting for your reply .
It would be difficult to comment on such a complex case without seeing the films and knowing the details.
Hello. Just had Heart Cath done one week ago. The Doctor said I have a 100 % blockage. He wants to treat it with medicine, no stint was out in. The medicine that is for this will it dissolve the blockage or break it up. And could it break up and go to the heart or brain and cause a stroke or heart attack. I have no pain at all. He said that the blood had rerouted its self around the heart. I’m taking blood pressure medicine and Lipitor and a baby aspirin every day. I go for a follow up on next Tuesday. I’m concerned about the medicine causing the blockage to break up and do more damage. Thanks for the info.
I’m 61 and had a heart cat done.They said right side was clear, but the left side was 5% blocked. My old diet was eating about anything. Is this an age thing or diet….
Dear Dr. Mustafa Ahmed,
I am a 68 years old Engineer & still continuing to be at helm of affairs of our family owned Pvt. 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. 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. None of our family did ever suffer any heart attack but having history of brain stroke. During end Nov, 2015 I had a Routine health Check up.When my Resting ECG found abnormal ,ECHO was normal & TMT was +ve .As per advise of cardiologist I performed Angiography (Catheratization done through groain) in last week December .On the CATH LAB Table the concerned specialized Cardiologist told that your Main Hear Vessel is clear but Left Vessel has 70% Blockages ,Right one has 90% and asked wheather I feel any pain in any Legs I said yes and against another query I replied it was in Right Leg. Immediately in the evening the cardiologist advised my family members was advised for 3-nos of stent implantation in a single procedure at hefty cost .When Our family members requested for only for Right Artery initially ,he denied & became furious and said ,if he has to perform Stent under no circumstances he will go in for only one and directed for Release from the Hospital on the very next day.When the Coronary Report was handed over we noted a difference in observations which were as under.
LMCA- 20-30% distal disease.
LAD- Non-significant disease at the site of D2.Diagonals non-signifcant atherosclerotic disease.
LCX- LCX after OM has 40-50% disease.OM mid segment 80% stenosis.
RCA- Dominant ,poor ,calibre with proximal non-significant 80% stenosis.
Recommendation- Right extend illiac 80% stenosis.PCI.
After having aforesaid episode & as I did not find any noticeable symptom consulted another independent Cardiologist Ex-head of cardiologist of a govt. P.G College ,with all Reports /CD etc. and as per his opinion ,he could find any reason to be worried immediately and not to go in for stent implantation immediately but to be on medication 1)AZTAR(80 mg) 2) Flavedon MR -1tab Twice daily 3) Clopitab-A150 and additionally the the medications that I am already on. Wait for a couple of months time to review the situation.
I shall be highly pleased if you kindly Give me your views ,wheather ,I have taken a too high risk.
Dr. Ahmed: I had a pacemaker placed and subsequently was told by 4 cardiologists in different parts if the country that the pacemaker was not needed. Is it possible to successfully remove a pacemaker and the leads?
Yes. A pacemaker can be removed, and the less time it has been in the easier it is to remove.
I am JAVED I want one question my mother rca 99% block lad 70 to 80% block lcx 70 to 80% block doctor advice me by pass surgery…pls tell me other options… My mother doesn’t have any diabetic problem no obesity ……….sir I’m very scar pls reply reply
Hi, In situations where there are a number of blockages and the disease is considered complex, bypass surgery has been associated with the best outcomes. Other situations would include heart muscle dysfunction and diabetes. Ask your Dr if this is considered complex disease which would not be severed well by stenting, in which case bypass may well be the preferred options and would give you an improved outcome over stents as far as current evidence goes.
Assalaamu alaikum Sir
My father did Angiogram on September 5th..Report has shown below..
LMCA – 40% plaque in shaft
LAD – 100%
Ramus – 85% Ostial lesion
Lcx – 90%
RCA — 100% in 3rd
Doctor advised to do heart open sergery
But we went with another doctor, he saw this report and gave tablets for 1 mnth.. after 1 mnth need to do a checkup.. we are very scared .. pease give valuable answer.. I know sir will defnitely give good solution..
Sir one more think someone live without rca artery…..if my mother rca will be 100% block what happen that time
Many people live normal lives even with an occluded RCA artery.
Hi,how does statin help in treating blockages in heart.I was prescribed fibator .I am obese .do I need to undergo angiogram to rule out blockages or stress test is enough.am heavy smoker trying to quit.does smoking causes plaque to build up in arteries.my age is 32.waiting for ur kind reply.thanks In advance
My relative 70yrs old male, had bypass surgery 12yrs old had a heart last week with 3 blockage valves. Doctor said there’s nothing can be done to fix those valves cuz he already had the bypass before. He’s been in the hospital with fluid in lung and kidney problem and on intubating tube. Dr wants remove the tube but between the fluid in the lung, kidney, they havent been able to remove the tube. The only open valve is working now was one of the valve they did the bypass before. What do you suggest? is there anything can be done to help the heart? Please help
I would suggest talking with the Dr looking after your relative. Its difficult to get a good picture of whats going on with the details provided and the details would need to be a lot more specific for me to be able to provide an insightful comment.
Hello Dr. I had a right side heart catheter with exercise a couple days ago. I have pulmonary arterial hypertension and recently my symptoms have increased. Especially in terms of syncope. During the procedure the Dr used the word occluded and 0 blood flow during exertion. Now when he talked to me after he didn’t mention this.only that my numbers showed what other tests had not and that I would be having medication Changes. How much should I be worried. Thank you.
I would call the Dr to clarify the test findings. The words occluded may well be referring to balloon wedge occlusion which is a normal part of the test.
My mom just had a major heart attack. she’s 67 and they just said that the biggest artery was 100% blocked. I know that they put a stent in it but haven’t gotten anything after that besides seeing her hooked up to machines and i know that she lost her pulse right before the paramedics came. she’s got blockages in her other arteries that they say medicine will fix but right now. I guess I just want to know what are the chances that she will come back? does it always take a long time for someone to just respond after that? would something like that have started as a feeling of awful acid reflux? was there any way to have stopped this?
So sorry for what you are going through, it must be extremely hard. How did she do?
Sir is tripple vessele disease not curable for medicine….rca 99% lad 70% to 80% lcx 70% to 80%…..doctor told me go for bypass… I’m very worry for my mother..she is very weak…what I do sir suggest me something…
I recently had a silent heart attack. I had 100% blockage in the RCA distal, collateral vessels did help and are functioning fine. 40% in the LCA and 0 blockage in the left circumflex. I exercise everyday and was even exercising when I was diagnosed with the RCA blockage. I was put on baby aspirin, toprol, Lipitor 10, Benicia which I have been on for 10 years. My lol was 138 in October 2915. My question can one manage this situation and avoid open heart surgery
What kind of exercise .. is it weigh lifting or only little exercise .. such walking jogging etc
Hello! My husband had a heart cath two weeks ago and was told he had a 100% blockage in the LAD. The doctor did not put in a stent, just gave him two medications to take and acted like this was no big deal. We will be getting a second opinion in a couple of weeks at Emory University in Atlanta. I am very worried for him and what the outcome will be. Do you have any advice?
i am wondering the outcome of your husbands outcome, Janice Crowe? my mom was diagnosed with this too but they DID do one stent however my concern is that she still has three arteries in front thats signfigantly blocked but dr says its not suitable for stents. She is 76 yrs old& is being treated with plavix & asprin thats it. my concern is that from all the research i have done is that her best option would have been bypass surgery. My uncle is 80 yrs old & he had open heart surgery twice last year -hes doing fantastic. I do realize that LAD diagnosis is called the widowmaker & is very serious thats why i am anxiously awaing a response from u. And i sure hope things with your husband have improved. Thinking for u both!!! thanks in advance.
Sir is tripple vessele disease not curable for medicine….rca 99% lad 70% to 80% lcx 70% to 80%…..doctor told me go for bypass… I’m very worry for my mother..she is very weak…what I do sir suggest me something…
I recently had a silent heart attack. I had 100% blockage in the RCA distal, collateral vessels did help and are functioning fine. 40% in the LCA and 0 blockage in the left circumflex. I exercise everyday and was even exercising when I was diagnosed with the RCA blockage. I was put on baby aspirin, toprol, Lipitor 10, Benicar 20 which I have been on for 10 years. My ldl was 138 in October 2014. My question can one manage this situation of the RCA and avoid open heart surgery
Open heart surgery would hardly ever be recommended for single vessel disease of the RCA. If asymptomatic medicine alone may be the best option depending on your tests especially if you were exercising and without symptoms.
Yes I have been exercising with no problems at all. 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.
Sir my mother has LCx 99% stenosis OM2 normal om3 small
LAD- proximal tubular 40% stenosis D1 2 mm ostial discrete 70% stenosis
RCA proximal RCA tubular 20%
Doctor said to do ptca with stent to om1
Sir,
Is it a severe case what type of food she can take.is she needs complete bed rest ??
Sir is tripple vessele disease not curable for medicine….rca 99% lad 70% to 80% lcx 70% to 80%…..doctor told me go for bypass… I’m very worry for my mother..she is very weak…what I do sir suggest me something…pls rply fast sir
Doctor,
I am blessed to see your page.My husband 56years had a mild attack in 2011. When we consulted a cardiologist he didnt gave much concern as he said it was a shock rather than attack, we left it as such.Now in 2016 he had a a special feeling of stuck and ECG was taken and it was abnormal. Angiogram saystype III vessel Mid Left anterior descending artery has long segment 70-80% disease.Diagonal 1 has 95%stenosis at its ostium with TIMI II flow distally. codominent vessel Obtuse marginal 1 has 40-50%disese. then codominent vessel proximal right coronary artery has 90% disease. echo normal. suggested angioplasty with 2 stent. While on the procedure patient suffered with severe pain on arm and only one stent put on 95% block portion. Now doctor was saying that another angioplasty has to be carried out through leg and 2 more stent has to be placed. Though in angiogram the block was 90%, when the plasty done doctor said it is 100%. How the situation happened? why couldnt doctor diagnoise things in the first instance and what was the cause for repeatation. The patients right arm through the plasty done became swollen very much with dark pink colour and became very much sick. What are the consequences? what was the cause for severe pain that the patient cannot tolerate? how the pink colour appeared guess due to internal bleeding. How it happened. The unattended block was lengthy and branched it seems. In this sitation where lengthy block of 100% with branch which needs 2 stents and another of 95% with already stented, was it the right decision to go for angioplasty rather than bypass. Can the patient undergo plasty within a short interval or will it take time. Afterall by pass or plasty was the preferred solution. Patient still has heavy pain and freezing feeling on hand.He is trotally scared also. How to proceed
From the report i would suggest that both an interventional cardiologist and a cardiac surgeon look at the films and give an opinion, Often complex disease will benefit from bypass surgery, although without seeing the films i can’t comment specifically.
proximal lad has discrete 80 stenosis before major D1
What does it mean?
Took my husband to the ER for severe shortness of breath, he was in cardiogenic shock,rushed straight to the cath lab, where they found 80% blockage in his main,and his LAD, and 100% blockage in his right coronary artery. They put in a balloon pump until they could get all the fluid off his lungs and then they did a triple bypass surgery. I just know that I am lucky that he is still alive.
Respected Sir
Would like to have your esteem opinion regarding a patient who happens to be my mother in law.
She had acute myocardial infarction was thrombolysed immediately
Angiography done after one month depressed
Showing 100% LAD blockage type3 with 50 to 60% RCA .LVEF depressed
Hope she is doing well. To give you any useful advice i would need to see the films and understand the situation better.
Sir is tripple vessele disease not curable for medicine….rca 99% lad 70% to 80% lcx 70% to 80%…..doctor told me go for bypass… I’m very worry for my mother..she is very weak…what I do sir suggest me something…pls rply fast sir…pls reply sir
Sir is tripple vessele disease not curable for medicine.rca 99% lad 70% to 80% lcx 70% to 80%…..doctor told me go for bypass… I’m very worry for my mother..she is very weak…what I do sir suggest me something.pls rply fast sir.pls reply sir
Hi I’m from Singapore I hv did my heart by pass op n my doc say my heart still weak . Only 40% working so how can I get better n strong heart back ?
In addition to the operation its important to be on the correct medication regimen that would include ACE inhibitors and beta blockers.
Hello Dr.Mustafa Ahmed,
The above was really wonderful article. I was going through even the others articles on heart health, tests, Cholesterol etc., I was surprised to know there is no specific procedures for diagnosing one’s heart health until he develops some symptoms. Many Doctors even in Emergency room performs only the standard tests such as EKG, Echo n TMT and concludes the heart health. My question is, is these tests sufficient to determine one heart health? How can I know my heart is healthy. I would really appreciate if you reply to my question since it will definitely help many of them worried about their heart. Looking forward to hear from you Dr.
Hello Dr.
It was wonderful reading this article and understanding the architecture of the artery. My mom had her engiography done yesterday and its shows 2 blocks. one in right artery with 80% lesion and the other on LAD with ostioproximal 80% lession.
Rest artery flow is normal. Dr have suggested for a 2 stent angioplasty. What do you recommend. Should I go ahead with the Angioplasty even in LAD.
Thanking you in anticipation.
It really depends on the complexity of the disease. In cases such as this it of course depends on the condition of the patient. For example is she a candidate for surgery. Also it is difficult to assess the true risks of stenting vs. bypass without seeing the films. In this setting however its usually recommended that an opinion is obtained from both a surgeon and a cardiologist to discuss the pro and cons of both. This is known as a heart team approach.
Sir
this side Mohammad aasif actually m suffering from blood pressure and my age is 24 i am feom kashmir.I have done my all tests but every thing is normal.But i dont do any test of heart .
I am reallly scared about this please give me suggestion what should i do …reply me on my mail please
My background 52 years old with no lifestyle contributing factors rather family history of heat disease with my father having a heart attack at the same age.
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. All blockages were cleared. With ongoing chest pain and several stays in hospital and stress tests which did not show up any issues during 2014/15, finally had angiogram performed December 2015 some 18 months after my 2014 heart attack which identified 2 new blockages on right at 50 and 80% which were above and below my original stents and these were subsequently stented and found 2 further narrowing on left side at 40 & 50% which were untreated
Again with further unexplained chest pain another angiogram was performed in March 2016 and have identified 2 more new narrowings on the right at 40 &50% which again are below the second stents and 1 additional on the left at 40% and above the main left artery at 20%.
My current status is main artery right side 2 narrowing 40&50%, Left side 3 narrowing with 2 very close together at 40&60% and 1 on side branch at 40% and 1 above left side at 20%.
My question is in a very short period of time I have had 4 more artery narrowing with 2 being below my last stents and none of these blockages showed up in the angiogram just 3 months earlier. Is it common for new blockage to appear within 3 months? plus is it common for blockages to appear directly above or below where stent are recently placed? What other factors might be at play which my doctors are not considering?
I continue to eat well with whole foods only and moderate exercise and cholesterol levels are now well within norms.
Thank you so much this brilliantly written article. And kudos for answering so many comments.
God bless.
Thank you so much for this brilliantly written article. And kudos for answering so many comments.
God bless.
Hello Dr Ahmed
My name is Mansoor. my father is 67 years old and in 2004 he did a by pass for 2 vessels now he had a problem one of his vessel is 99% block and the doctors said that stent can not be used because that vessel is bended with 360 degrees and the stent can not be moved in the vessel also his doctor tried it through angioplasty but his answers was No ….
Now plzzz doctors tell me what should be done ?? we all are very worried for him plzzz doctor give us the solution….
u can reply me here and if u can email that will the best..
thank you Sir
its very much urgent…
Hi, to give you a proper opinion one would have to see a lot more information including an angiogram, i suggest you obtain an urgent second opinion if you are concerned.
Sir my mother-in-law age is 68 years and she is suffering from heart attack from last 3 days angiography is done report says above 80 percent block in 3 room doctor suggested open heat surgery , is it possible by any medicine to clear blockage or we can go with surgery . Please give me fast suggestion sir
Hello, I appreciate your articles as I am trying to understand what is going on with my 81-year-old mother’s heart. I am surprised that the cardiologist wants to do angiogram then stent or call in surgeon for open heart surgery on someone so old. Is this common? I am very worried that the risks of the procedure(s) seem possibly more hazardous than the risks of doing nothing/encouraging her not to engage in strenuous activities. Apparently she was able to walk on the treadmill for only 3-1/2 minutes during the stress test and they didn’t proceed to the second/chemical part of the test. Is that significant?
Hi, It is possible that the stress test was so positive from just the exercise portion that the decision to perform an angiogram was made simple and no further benefit gained from imaging. Basically meaning that if the exercise portion was very positive then imaging wouldn’t alter the need to proceed to an invasive evaluation as we already know she is in a group of people with a high pre test probability of coronary disease. (assuming a correct interpretation of the test). Typically the next decision regarding stent vs. surgery if needed, will take in to account the health status of your mother, her age, her co-morbidities and the whole picture. Hopefully no one would be excited about taking an 81 year old to surgery particularly if they are frail and have other concomitant illnesses unless it is truly the most appropriate option.
Hello Dr. Ahmed,
I am 51 years old and recently had a stent put in the right coronary artery down where it Ys into two arteries. I have 50% blockage in the LAD and now am on medicine in line with what you suggest.
I have been experiencing slight pain on left side of chest and slight pressure in chest but by no means like the heart attack symptoms. My nurse recommended to relax for an hour and if it gets worse go in to the hospital. Is this normal, for post heart attack stent procedure, to experience? Should I be concerned or will have to adjust and live w it?
Thank you Dr. Ahmed, your articles have been very helpful and insightful.
I would recommend you go an see your cardiologist to ensure you don’t need any further form of risk stratification testing. Hopefully its nothing, and in general 50% blockage isn’t a critical issue, but its not worth taking a chance.
Sir pls reply it is possible Dr done angioplasty before did any blood test echo other test…they done angioplasty of my mother without any test behaf of see two month of before report..I lost my mother…. It is medical neglence case or not…..
Hi Sir
CT CAG Report for my uncle and age of 59 years,
1) Calcium score – 8.9
2) D2 showing short segment circumferential calcific plaque causing severe degree narrowing
3) Tiny eccentric calcific plaque in mid circumflex artery causing minimal lumina narrowing.
Please suggest.
Thanks in advance
Dear Dr. Ahmed
Jan 2002 I had by pass surgery, since then I had problems with the blood circulations, March 14 of this year angio was done results showed that I have 2 vessel native coronary artery disease. 100% ostial LAD, 100% 1st OM, 40% ostial left circumflex, 30% ostial RCA and 40% distal RCA at take off of the marginal branch. SVG – OM is patent minimal retrograde flow. LIMA – LAD 40% at anastomosis to LAD and 90% occlusion at entry of skip graft to diagonal. I was told that at this time nothing can be done and I am taking medication to keep the blood flow. Is there anything I can do??
Hi, It’s very difficult to say without seeing the films. It looks like most of the major territories are revascularized and so no intervention would be necessary. The best thing you can do is, medicine, diet, healthy lifestyle, exercise etc. It goes a long way and can help you do well for a long time.
Hi Doctor
I’m 38yrs female, I have had kidney disease for 28yrs and currently have a wonderful working transplant for 18yrs. Was diagnosised with CAD last May, 90% blockage in my LAD it was stented and an 80% blockage in my RCA not stented. And a EF of 70% My stress test after the cath was basically normal, I’m not symptomatic, I exercise and am under weight. But feel like a ticking time bomb with still having an 80% blockage . Blood thinners/Lipitor instead of another stent. Doc says with test results being normal not always good to start putting stents in when its not absolutely necessary. Your thoughts? Agree?
Sir pls reply it is possible Dr done angioplasty before did any blood test echo other test…they done angioplasty of my mother without any test behaf of see two month of before report..I lost my mother…. It is medical neglence case or not…..
Reply
My husband (58 yrs.) just had an angiogram. It showed 100% blockage in the right artery and about 40% & 50% in two of the left arteries. The Cardiologist mentioned that on the right, at the bottom, some small “arteries” have created their own “bypass” offering 10-20% flow from right to left? (I didn’t really understand this part). Prior, his vascular specialist had ordered an abdominal sonogram, which he had 2 months ago. He has not heard from him at all, but his GP received the results and advised him 3 weeks ago that it showed a 5.4cm abdominal aortic aneurysm (near the kidney) and she was going to write to the surgeon asking what the plan was. 2 years prior, this same vascular specialist did tests which showed 70% & 80% blockages in the carotid arteries, from which he was put on meds for cholesterol and aspirin at that time. Also, 2 months ago, the cardiologist added a med for angina (husband has developed a lot of chest pain about 4-5 months ago) and after the angiogram, added yet another “similar” med plus doubled his med for cholesterol. 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. Other than that, made an appointment to return to him in a month. All this is not sitting well with me. Part of me thinks a more aggressive approach is required, instead of this “wait-and-see” method. About 3 years ago, my husband quit smoking, eating better, exercising to ensure his weight is in the correct range for his body/age/etc. (however, exercise is now too hard because of the chest pain it brings on and he has had some weight gain, although he wouldn’t be termed obese or anything). He has always been a hard worker and doesn’t like being idle. I’m looking for some information to educate me on how I can assist in getting the best medical approach to my husband’s situation. We both are prepared to accept “inevitability”, but not if there are treatments which we should be asking for which haven’t yet been presented as options.
Dr. Ahmed, this article was great in explaianing blockage.
My husband had a silent heart attack and underwent many tests. The surgeon
showed us a picture of the heart indicating where the blockages were
and the per cent. There were so many indicated and they ranged from 80% to
95%. The surgeon said there was no way of helping him with surgery and sent him
home. We are all stunned. Can you give us any indication of how long he might live.
We are trying to do all his favourite things including a trip to Hawaii, but are afraid to
go too far.
Dear Sir ,
You post are really very educational.
My father age 65 was suffering from atrial flutter. He went for EP study and RFA. Angiogram was also done. During the process a non dominant mid 90% lesion was detected in RCA.
Since he did not have any symptoms, we did not go for angioplasty immediately.
Kindly suggest is it necessary to go for angioplasty even if he does not show any symptoms ?
For a non dominant RCA without symptoms, stenting is not necessarily advised
thanks a lot doctor i cannot express my gratitude for your answer.
After the RFA , my father had a brief episode of flutter which lasted around 5-6 hours.
As we decided not to go for angioplasty, the doctor stated that flutter as recurred due to Blocked RCA, and prescribed a lot of medicines
i was suggested the following medication.
1. Atorva CV 1 tab daily
2. Cordarone X 200mg Daily twice
3. Metolar xr 25 1tab daily
4. Cardace 2.5 daily
5. xarelto / ixarola 15mg daily
i was told to continue these medicines for 90 days then go for a follow up again.
before the procedure i was not in any medication.
i have not begun the medication yet.
is it possible that the flutter has recurred due to the blockage in RCA ?
is it possible for you to see my reports if i send them to you ?
Hello! I had a heart attack back in May 2015! Found that 2 arteries were blocked! Doctor put two scents in. I kept having chest pains, they did ekg and blood work kept coming back normal. In January I went back to hospital with the same symptoms they did the same thing all test came back normal but they admitted me so they could do another heart cath to find one of the scents was 98% blocked they fixed it and changed my medication. Well it’s April of 2016 and I’m back in the hospital with the same story, another heart cath and same thing! Doctor can’t seem to figure out why this Stent isn’t cooperating. Is this something that could possibly lead to something major?
Sir,
My father age 63, he was suffering from heart attack last week. today angiography they told there are two blockages in left side & they directly suggest by-pass. It is advisable or can we go for angioplasty. my father already sugar patient. can we go for bypass or angioplasty is suitable.
Please suggest.
Its not really possible to advise without seeing the films and knowing the history, each case differs regarding the best option, and in borderline cases its often better to see a surgeon and a cardiologist in what is known as a heart team approach.
Hi doctor Mustafa Ahmed, sir I have a question sir my mother did her angiography last week doctor said she has blockage in her arteries 95%,70%,and 35%. She has diabetes and high blood pressure ,doctor advised her do bipass surgery . We are scared about the surgery kindly please advise us ….whether this problem can be treated with medicine or stent. Or she has to go through surgery , Sir please reply asap , I will be very thankful to u
In diabetic patients with multiple blocked arteries, bypass surgery may be the preferred option, particularly if the left main coronary or the proximal left anterior descending artery is involved, its difficult to be specific without seeing the films themselves.
Thank you very much doctor,that really helped……she went to hospital last Saturday for surgery, in her blood test her TLC was 14000 . Surgeon said to her that they can’t do surgery at this point….they said we have to give u medicine for 5 days then we will test your TLC again , he sent her home , we are worried that is it alright to stay at home in this situation? Please suggest sir .
Hello sir, it’s little long but about I’ve doubt Dr are cheating..
Before 15days My father was walking, after 1km he felt pain in chest.(General not walks, bike-car)
Yesterday 4am my father was getting small pain in chest and he just breath in and in,hard to out breath..
We emergencly went hospital
During blood take it was thick
Ecg was not proper they said
Than Dc did xray,sonography
sonography,echo test
After test Dr sent to other heart hospital
Said No walk only wheelchair..(rest for weeks)
Than Said it was some kind of heart attack or heart function failure,
Heart is getting 35% blood
N test positive to heart attack
N puted him in icu where we only can meet him 3 time in day for couple minutes,
N they will do blockage test after 2 days.
Now my main confusion
My father friend,a society friend,and an uncle told that this hospital is totally shame they just intrested in money, they’re fraud
Frend said once a old man was died in icu but the kept him to make a more one day bill,hospital said it’s serious so nobody can get bychance a family member went in and found old guy is dead
dead..
Now I’m really scared what to do i live in small city no many heart hospital n specialy they’re saying no,walk,moving danger, the have kept reports..
So what should i do?
Is this 35%blood is really dangerous ?
Should we kept him there?
Do you have the results of the echo test and is there a plan to perform arteriography.
Dear Dr. Mustafa,
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.
And Dr gave the drug medication for 6 (six) months to soften the blockage and afterward to do again the angiography for stenting.
Kindly please advise the above case from experience you have and whether the drug treatment is recommeded for whole my live?
Thank you and best regards
Yan
Dear Dr. Ahmed
In 2011 I had a pelvis CT, but for some reason they did a heart CT at the same time. The paper with the results said moderate plaque. I was kinda worried, so I showed my general practitioner. He said that was normal and that everyone has plaque – no big deal. But now 5 years later I’m still wondering if there should have been some treatment for this. Out of fear I’m taking all kinds of supplements (Niacin, Magnesium, Fish oil, Vitamin K2, D3, B6, B12, CoQ10 etc.) I’m almost 48 years now. Is this really no big deal? Any tests I should have?
Thank you.
Correction. It wasn’t a heart ct but a abdomen ct, and it said ‘moderate aortic plaque’.
hi doctor,my father’s medical history
diabetes since 20 yrs,ptca to lad 2005,ptca to pda 2006
he had angiography done last week since his stress test was positive.results are
ltcx; non dominant 70%proximal lesion.distal ltcx has 30%plaque
ramus;good sized vessel 70/75%proximal stenosis
rca;dominant calcified vessel 60/65%lesion in mid segment.
stent in distal rca is patent .pda has 2o/30%plaque
peripheral;lima/rima normal
renals;normal
he has been advised cabg.
please tell us what is the better course of treatment at this stage,would a complete by pass surgery be better then stenting or can this be managed with just medicines
Thankyou
A simple answer please…once all arteries r blocked how long can u keep breathing n is there pain??
Hello Doctor,
My grandpa is a 84 ages old man, he was been checked out he has coronary artery blockage, and shown on the colored ultrasound his coronary artery over 70% block out. I looked up a lot information and by the doctor advise he better do a stent placement .(I don’t know they can do balloon angioplasty or not because I just know this treatment today ) However, he has to take a kind of medical named Plavix over one year, but this medicine has a strong side affect to his stomach disease so his doctor was saying that he do not suggest my grandpa to do a stent placement. Is there have other chooses for my grandpa? Can he do the balloon angioplasty ?More than thanks for read and looking forward your reply!
I’m 66 years old and don’t have any coronary blockage or diabetes. Females do not prepare any food for me. Women have no say about what I eat and they never cook or prepare anything for me.
I’m using this site for research on my homework, and its working out great!
Hi Dr
Very informative site
Can I ask, my friend male 36 years old had a heart attack and had a stent put in. Now after an echo, the result is an ef of 43%
He used to smoke and stresses a lot, but was also a gym rat
What is his prognosis…can healthy eating and exercise reverse all this or is it inevitable that this will worsen in time
Should he get married? He is also worried about whether the lower ef or drug side effect will cause erectile dysfunction
Will he ever be able to come off these drugs and are there any natural alternatives
Many thanks
My 74 yr old father had a Coronary Artery Bypass Surgery in 2003. On Tuesday, he went into cardiac arrest. His heart stopped for several minutes. He is still in CCU. The cardiologist informed us that the main artery that was replaced during the CABS is the only open artery. The remaining arteries are all blocked and there is nothing that can be done. The have finished the warming of his his body from the hypothermia treatment and as of yesterday he is breathing on his own. What will this mean for him when he comes home? Can you function fully will only one open artery? Even if it is the main artery…
Thank you ahead of time for you expertise.
btw.. the reason a am asking here is that it is extremely frustrating in the hospital. The doctors will not give you all of the answers that you so desperately want.
Hi,
It really is difficult to give an answer without a lot more information, i can tell you that the two key factors will be how much the brain was affected and also the residual function of the heart, ask them for a clear answer regarding those two factors and ask for neurologic prognosis. If the heart function is reasonable then yes people can function to a degree with the main bypass open. 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.
Dr. I have 3 stents in LAD. Just had another heart cath and was told I have 20% blockage in left main and I will have to have open heart surgery when it gets to 50%. How will I know when it gets to 50%. My dr. said they would not do an annual stress test like they have been.
Sir, my father has 99%blockage in right coronary artery and some blockage in LAD.. so wats the best procedure of treatment? Plzz help me.Will it be Stent procedure or CABG? i mean whats the appropriate procedure??
It is different in every circumstance and depends on many factors, would need to see the pictures also.
Dr. – I had a nuclear stress test a few weeks ago which revealed a blockage. To look confirm the blockage the cardiologist ordered CTA instead of Angiography. I have done several CT scans and been exposed with radiation a lot and wondering if I can do MRA instead of CTA. I also want to know if MRA will give the same result as CTA
MRI scan for evaluation of coronary stenosis is not as reliable as CT, i do however understand the reluctance to be exposed to ionizing radiation, discuss with your physician.
Dr. Ahmed, I had a nuclear stress test a few weeks ago which revealed a blockage. To confirm the blockage the cardiologist ordered CTA instead of Angiography. I have done several CT scans and been exposed with radiation a lot and wondering if I can do MRA instead of CTA. I also want to know if MRA will give the same result as CTA
Well thank you very much for informing such unknown fact.
I have a question, if the disease is curable in home or one have to visit hospitaly occationaly?
I would recommend a specialist guide the treatment if possible.
Sir My father is 52 years old he has the history of hypertension, diabetes and asthama recently he was hospitalized and was diagnosed as
LM: Mild wedging eccentric plaque 25%
LAD : Osital 25%
LCX: OM2-minor plaque
RCA: Distal 100%
Stress thallium result is
Scarred mid interior, basal inferior, mid infero-lateral and basal infero-lateral segments of LV myocardium.
The echo report 28 days earlier was
Hypokinesia in RCA territory
Normal valves,LVEF 30-35%
No PE/clot/veg.
Right now the doctors have suggested
Diplatt-A 75/75
Storvas 80mg
Eptus 25mg
Glador M
Sompraz D
Betaloc 12.5 mg
Cardace 2.5mg
The medication has to be continued and after 2 weeks they will do the echo and will decide for AICD implant
I want to know the seriousness of the patient and is the treatment OK.
Were any stents placed? Typically one would wait 3 months after optimization of medical treatment prior to ICD implantation unless there have been high risk events occur, sometimes there can be recovery of function. Its difficult to comment without knowing all the details however or seeing the patient.
No no stents were placed
Does Distal RCA affects a lot
If his LVEf increases then will it be ok
This helped me clearly understand the angiogram report I had seen yesterday of my father… thanks a lot sir for the detailed and clear explanation
R/Sir .
iam dur muhammad baloch .sir my heart one vessel is blocked sir iam so poor person . i can,t afford this treatment sir . how i manage our heart problem . one thing plz mension sir . i can,t feel any pain . iam totally physical fit . sir i need u r advise . sir iam student . my age above 25
Dear Doctor Ahmed,
Thanks for sharing excellent article!
My brother aged 43 with strong family history of cardiac problems had drug eluding stent placed in RCA 18 months before, last week he had chest pain & taken to ER.
Initial EKG was normal & enzyme test also showed negative, enzyme test was repeated after 4 hours & it came out positive (Troponin 0.04) & after 12 hours Troponin was 0.09.
He went thru angiogram & 99% blockage on RCA was found above the stent area, the stent is working fine & 99% blockage in LCX.
went for angioplasty for both the blockage & drug eluding stents place yesterday.
Was stenting the best option?
Can you please suggest what precaution he has to take further.
If you can provide your email id can forward the complete reports to you.
Respected sir,
My father had a heart attack. He is 50 yrs old. He is not physically fit and was found to have 90% blocks in 6 different places. The Doctor says that in three places, stents cannot be placed as the size of arteries are less than 2 mm. He recommended blood thinners for the rest of his life. Do these “unstented” arteries cause problems in the future? Please answer my question sir.
He also has Diabetes, High blood pressure, Hepatitis B and Asthama.
My Father (74) diagnosed with 70% block in the OSTIAL LAD artery. His blood pressure remained around 80/175 even with blood thinner medicine and he also on insulin. Doctor suggests stent placement in the LAD after CTA. On July 14, 2016 his CT angiography was done and if required I will send images to you. When he walks around 400 meters he feel shortness in breathing and felt tired. Please suggest.
I have heard that there is new technology regarding opening of calcified arteries and placement of stents and wanted to know more about it from another standpoint, rather than a sales video. I had a nonSTEMI in Sept of 2015. 95% blockage of the Left coronary artery was treated with angioplasty and stent placement. I also have 100% occlusion in the RCA that is calcified and I suspect has been the reason for me return trip to the Emergency Dept. for chest pain and SOB. The Cardiologist performing the angio said that he was unable to get through the total blockage in September, but now he says there are special tools. How safe is this coronary atherectomy procedure?
He is likely referring to chronic total occlusion (CTO) techniques or rot ablation, atherectomy itself performed in good hands is a useful procedure and allows placement of stents in calcified vessels. CTO work itself is a little more niche and i believe should be performed by someone with a special interest in that.
Dear Doctor Ahmed,
Thanks for sharing excellent article!
My brother aged 43 with strong family history of cardiac problems had drug eluding stent placed in RCA 18 months before, last week he had chest pain & taken to ER.
Initial EKG was normal & enzyme test also showed negative, enzyme test was repeated after 4 hours & it came out positive (Troponin 0.04) & after 12 hours Troponin was 0.09.
He went thru angiogram & 99% blockage on RCA was found above the stent area, the stent is working fine & 99% blockage in LCX.
went for angioplasty for both the blockage & drug eluding stents place yesterday.
Was stenting the best option?
Can you please suggest what precaution he has to take further.
If you can provide your email id can forward the complete reports to you
Dear Dr. Mustafa Ahmad,
Sir my Father (74) diagnosed with 70% block in the OSTIAL LAD artery. His blood pressure remained around 80/175 even with blood thinner medicine and he also on insulin. Doctor suggests stent placement in the LAD after CTA. On July 14, 2016 his CT angiography was done and if required I will send images to you. When he walks around 400 meters he feel shortness in breathing and felt tired. Please suggest
Dear Doctor
Age 33 left side heart 90 % block doctor use the medical terms LCX. Pls. advice best latest treatment available and also advice any latest treatment found against TAR.
Would need to see a lot more information to even begin to comment. What was the opinion of your cardiologist familiar with the case?
Dear Dr Mustafa Ahmed Sir,
I happend to read your articles and advise on difficult topic of heart related disease which is so lucidly written.
I request your comments for my aliment which is described below:
I am Abbasi Vilayatwala from India . am 59 years Old. My family has history of heart disease. As per recent bollod report I have high Choloestrol (254) > and Triglyricides > 754 mgdl. As I am having chest discomfornt and slight pain in the chest Recently on 1-08-2016 my MDCT Angiography is done and conclusion of the report is as under :
Eccentric mixed plaque in the distal LMCA causing mild narrowing (50% diameter narrowing)
Multiple eccentric mixed plaques in the proximal LAD cuasing moderate to significant narrowing ( around 65-85% diameter narrowing). Few mixed plaques in the mid LAD causing mild narrowing (50% diameter narrowing).
Mixed plaque in the proximal LCX causing mild narrowing (50% diameter narrowing).
Few mixed plaques seen in the proximal RCA cauasing mild to moderate irregular rarrowing (around 45-55% diameter narrowing).
I planned to perform Haj this year and my departure date for it is 5th Sep. 2016 and duration of stay at Mecca/ Media would be of 5 days.
I request your advice as to type of treatment to taken by me, like medicine and /or stent insertion. Would it be ok to perform Haj or considering my condition it pose any risk. Whether I can go for stent, if so advised, and then go for haj in say next 15 days.
Considering above circumstances, I request your early reply please.
Thanks
Its a difficult question to answer. The main issue with traveling is that if you run in to trouble then there is no immediately available medical help. 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. The concern of not doing anything is that you won’t be able to do your trip and exert yourself as would be required. The whole trip would be like a stress test. Ultimately the decision is yours. From a medical standpoint investigating and treating the symptoms first would be recommended. If stents are placed, the decision to travel would be dependent on the procedure or treatment required and needs to be discussed with the treating physician.
I’m in my younger 50’s. Knew something wasn’t right 9 days ago. I had bad chest pains, shoulders and neck pain. This lasted for hours. I knew I had an appointment with my primary that sent me to a cardiologist after he read an ekg.
The Cardiologist evaluated me and decided to give me a heart catheterization that night and kept me in the hospital. An Echo was done in the morning. I did have a minor heart attack that damaged the lower chamber. Plus, I’m 100% blocked on my right side and partially on the other. He said my collateral arteries are picking up the slack. He is trying to control this using medications. I must say this was scary news. I’m in a constant daze.
My problem, I’ve been extremely tired since the episode 9 days ago. I average walking up 11 stairs a day (with my job) and 4 – 5 miles of walking daily. One flight of stairs or a walk to the next block leaves me breathless now. Let alone the driving I do in this daze I’m in. I am certainly getting enough sleep, about 10 hours a night. Wake up and my legs, ankles & feet feel like their frozen. This is a nice article that helps me understand the catheterization. I was lucky that they used my arm for it. But, I feel like there’s not much hope with so much blockage and so much medication. The nurse practitioner asked if I could take a few weeks off of work. That’s not really possible. I’m just very confused about what the outcome will be. Do I try some life changing activities in diet or if that main artery is blocked, accept it’s a matter of time.
I had bypassx5 I now have 3of the 5 arteries with blockage Dr says they can’t do bypass again because grafts don’t like to take the 2nd time gonna try to treat with meds is it not common to have bypass twice I would like to have bypass again is it just out of the question to try again?
Bypass can certainly be done twice if needed.
These pictures and explanations do not completely explain to me the difference between the LAD and the D1.
Is 70% blockage of D1 as bad as the same blockage of the LAD or worse?
That is getting in to a little more detail. The D1 is a branch of the LAD. The D1 is smaller than the LAD and therefore a blockage in D1 is not typically as bad as say having a 70% blockage in the LAD. Where as 70% LAD lesions are often treated with stents for example, a 70% D1 lesion is often treated with medicine alone.
If there is a blockage on the right side of the heart is it any serious please explain or to take medicines
Hi, dr mustafa Ahmed.
We are told that My dad’s left artery is 80% blocked. He had angioplasty 2 years back in right artery after the heart attack. I want to ask if is it possible to do angioplasty again or we’ll have to go for bypass?
And how much time does he have before this 80% blockage exceeds to more dangerous level. And how early should he go for the surgery?
I would need to see the films and understand the situation better to comment. A stress test may be beneficial to answer the significance of the lesion.
Great website! I’m a senior nursing student who just witnessed my first heart cath on a patient. Your images and explanations have helped me more clearly understand what I saw today! Thank you for the excellent teaching.
Hi sir,
My father had recently bypass surgery (a triple vessel disease) and rca is was non graftable and report says RCA is totally atherosclerotic with no lumen.my question is he can live a normal life without RCA and any suggestions please.
If he has the development of collateral circulation, he may do just fine.
Dear Dr. Mustafa Ahmed , My Grand father age abut 70years, he is doing good and quit normal. As he crossed 70years age, went for regular check-up package and found some hart disease while CT angiogram. So, referred for angiogram found observations as below. As old age, TMT not referred by physician.
RAMUS is mild disease, small caliber vessel
LCX is dominant artery , proximal LCX mild disease, distal LCX eccentric 20% disease
OM2 is 2mm vessel mild disease
OM3 is 2.5mm vessel, mild diffuse disease
RCA is non-dominant artery, proximal RCA tight stenosis of 95% severity.
Small caliber vessel, OM1 small vessel, LPDA found normal.
is it curable with medicine or advice to go for surgery or stints plant ? please give me your valuable advice, Thank you
Hard to give you sound advice without knowing the case and seeing the patient. In general however, he has a non dominant RCA with a blockage, this would usually be treated with medicines. The LAD is not commented on and would be important also.
sir,
my father 65% blockage in right side . ki hum ko bipass karvane chia ja medicine lane chaiye
Hi doctor i had a angioplasty stent on last year doctor told me have 3 block which is main arteries, one of the arteries was 100% block can’t do the stenting another is too small can’t do angioplasty sick for your advice thank you.
Is there a rare type of heart blockage that there are only 8 cases known and if so, is there a certain named to which is has been given?
Hello sir, my father aged 72 had three blocks (One is 100% & other two are more than 70%) and doctor treated with stents in two blocks and left the 100% block for time being. Doctor informed that after 3 weeks it will be done. Whether 100% block can be opened with stent and what is the success rate. When we took the opinion of other doctors, they told 95% it is not possible to open 100% blocks. Please clarify…
Can you provide details of the actual report, what is the function of the heart also? Does he have symptoms? Most total blockages can be opened by experts in doing that, however whether to open it or not is another question that needs through thought and evaluation. Im surprised he didn’t go for surgery initially.
dr ahmad
what treatment should be in case of 50% narrowing in RCA?
Medical treatment. Aspirin, statin, maybe beta blocker, control blood pressure, stop smoking, exercise, diet, lifestyle changes.
dear dr
can i have your whats up nomber so ill sent you the angio vedios?
I would recommend contacting vitalengine.com as a method of image sharing.
why statin,they are more risks that benefits with the statin,the lever cannot fully produce the good cholesterol,and the bad cholesterol(LDL) is not the correct name and is necessary to transport the HDL through the body,and so much complains about pain in the muscles and articulations,is not the heart a muscle may be?a life style change is more efficient that the statin but it is so easy with statin,everyone think ok i can eat and drink what i want the medication will close the tap of cholesterol produced from the lever,and i will not go further the are so much side effects like destroying Cqo enzyme!!!
I respect everyones opinion, but as a medical professional that is well versed in research i will make recommendations on sound evidence. Its important to keep in mind that we are talking here about statins as secondary prevention, not primary prevention.
Thanks doctor Mustufa for such a nice information, I want to ask that is it possible that even though patient has 90% heart blockage but he does not feel any sweating, fatigue, BP fluctuation, tiredness and even pain. Patient is not even diabetic. Is it possible to remove the blockage through medicine?
Thanks in advanced if you can help.
The blockage itself is not likely to regress significantly, however depending on the location, the nature of testing, and patient clinical stability, even in the case of 90% lesions medicine can sometimes be used effectively.
Sir,
This is the results of a calcium scan done on my heart recently. I don’t have diabetes, quit smoking 2 years ago, and I am overweight. From what I understand from your writings, in my particular case you recommend medical therapy versus stenting since my stress test was negative? My EKG is abnormal and indicates a previous heart attack or blockage, but my doctor says not necessarily so. Please advise. Thank you.
Report:
CCTA WITH CORONARY ARTERY CALCIUM SCORE: Indication: Atypical
chest pain in 54-year-old with negative exercise stress test. TTE
with moderate LVH and EF of 60%
COMPARISON: None
PROCEDURE: CT of the heart was obtained using prospective EKG
triggering without the use of contrast media is.
EXTRACARDIAC FINDINGS: Very minimal dependent hypoventilatory
changes within the visualized portions of both lungs. No pleural
effusions are identified. There is no evidence of lymphadenopathy
within visualized portions of the mediastinum and bilateral hilar
regions. Limited evaluation of the visualized portions of the
esophagus, stomach, liver and spleen demonstrate no gross focal
abnormalities. No significant atherosclerotic changes are
identified in the visualized portions of the aorta. There are
mild degenerative changes throughout the visualized portions of
the spine. No aggressive osseous lesions are identified.
AGATSTON SCORE: Total coronary artery calcium score is 121,
distributed as left main (LM) coronary artery 0, left anterior
descending (LAD) 121, left circumflex coronary artery (LCx) 0,
right coronary artery (RCA) 0; 84 % of similar patients have less
coronary artery calcium.
CARDIAC MORPHOLOGY: The right atrium, right ventricle, left
ventricle and left atrium demonstrate normal size and morphology.
The pericardium appears grossly normal.
Moderate atherosclerotic calcified plaque identified within the
proximal segment of the LAD without evidence of calcified
atherosclerotic plaque throughout the remaining coronary arterial
tree.
Impression:
1. Moderate calcified atherosclerotic plaques within the proximal
If you had a stress test and it was negative, with a moderate stable lesion medical therapy is likely recommended.
Husband treating slightly elevated chloresterol & blood pressure slight too but being treated.
Doing work at 91 yr olds fathers home after Hurricane ends up in hospital mild chest tightening tingling arm. They tried to see if stent or angioplasty would work. Healthy otherwise 69 yrs. mom died of stroke dad 91 feels like 71 & on no meds.
Cathy look shows 2 vessels 80% they keep saying BACK of the LOWER part of his
heart WHICH Vessels would affect BACK of His heart. They want Bypass we are in FL & want to fly home to University of Iowa where we live. He was just 4 days ago put on Plavix, some other common heart drug & carries Nitro they gave him. Does flying home sound at least pretty safe. Nothing heart before helping 91 yr old Dad with Hurricane Matthew recovery. Is a 2 hour plane ride any more dangerous that 2 hours sittin here in FL. ? Also plz answer “BACK OF HEART- LOWER CHANBERS”. Possible- meaning especially “BACK OF”—I know ventricles am a former OR Scrub.
What are the lifestyle and dietary changes a person has to make if he/she has mild blockage around 30% in heart? What is the treatment for this?
Stopping smoking in smokers, controlling diabetes in diabetics, controlling blood pressure, cholesterol, lifestyle, exercise, being aware of symptoms.
Your tutorial. realy helped me understand so many things. My dr put in 4 stents in formation in my right artery from Howerver he did not stent my left artery that had 60 % bloquages in the two mid lad. I asked him why he didn’t stent them he just said that he wanted to treat them agressively with meds and he just said there would be too many stents. So I left the hospital wth tenormin, plavix, asa however he did not prescribe a statin?
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. Also is it normal to feel some of the same symptoms angina and have shoulder and neck pains. my procedure was done 7 days ago. I feel sad and maybe depressed being called à cardiac patient. I don’t even know when I can return to work. i am 62 and female, normal weight no diabetise ( mom and dad both had insuline dep. diab dad at 55 had 3 artary bypasse surgery and 2 more after as well as 2 later aneurisms to both thighs however I feel that we were privileged to have him with us for 13 more happy years)
My questions are about futur stents or by-pass possibility is this wthin a few years or ?
Feeling vulnerable and weepy after stents normal?
Is putting 4 stents in a right artery common ( from 1 to 5 and the stents total 120 mm) dominent right ?
I cant upload the drwing with info they gave me.
Thank you ever so much for all your work and info
Its ok yo feel vulnerable after you have undergone such procedures, it can be scary.
In some cases multiple stents are required simply because the extent of the disease is so large, its not ideal but can be needed.
As for future stents or bypass i really would need to see the films to answer.
Thank you for your quick reply.
Is similar unstable angina commonplace after this type of intervention ( left shoulder, a little nausia at rest in the evening and night sweats early morning. Should I go into emergency if it continues? Go to family doctor? My post op is the 13th of jan 2017 with cardiologist.
It seems no damage was done to my heart. Very lucky it seems.
I tire easily is this normal? as according to most articles I should be walking at least 20-30 mins. That I can’t do.
I am normally very active now I am so tired all the time, nomal?
Thank you for your educational info a great service to simplify understanding heart problems. I work with physically handicaped young adults at a day activity center and would like to implement some kind of excercise program for and with them as I noticed they all seem to have high resting pulses and will use your images to help explain the heart muscle.
You’ve inspired me to get this going. Thanks again
Hi. You are doing great service to humanity! I am 55 and had MI in August 2016. 1 stent put in for 100% blockage. Still have an 80% a 40% and a 50% block. Treating with medications. Cut my smoking from 15 a day to 2-3 and some days none. I am so tired all the time and so depressed and scared to do anything stressful including going back to stress job. What’s my best course of action? Can you suggest anything?
With modern day treatment of heart disease there is no reason you cant live an essentially entirely normal life. Of course this only works if you do your part, and its great you have cut down on smoking but the few you smoke still put you at markedly increased risk. In addition to compliance with medications and treatment plan I suggest that you ask to be referred to cardiac rehab which will give you a good idea of what your exercise capability is and also increase your confidence in your treatment.
Sir, I just want to make it to the point & precise as we both have shortage of time.Hope you will understand.
Patient-My Father, age-61, weight-58.5kg which is 1kg less than last record, height- 5ft 4 inch, not at all diabetic, every single blood report like creatinine to Hb all are normal, current B.P.- 120/80 (usually +/-10). No sign of Angina, no chest pain, no shortage of breathe, no fatigue.
History- 1.5 month before he was feeling breathlessness & mainly right side back pain for two days. But then naturally it was gone. That was the reason to visit Doctor. He then referred to Cardiologist after seeing ECG. The Cardiologist confirmed a mild stroke after seeing the ECG & Echo, gave medicine and told to do Angiograme immediately. And then confirmed LAD 100% + RCA 90% blockage. Still feeling nothing special. But He said Angioplaty is not possible. Open heart is the only way. THAT IS THE QUESTION – CAN THIS TYPE OF BLOCKAGE POSSIBLE WITHOUT THE SYMPTOMS FOR SUCH A PERSON WHO IS ACTIVE, NEVER A SMOKER/DRINKER, A RELIGIOUS & ROUTINE GUY? ONLY OPEN HEART IS THE WAY, NO OTHER WAY?
In such a setting where there is 100% occlusion of the LAD and 90% rica surgery may well be the best option if advised and he is felt to be a candidate.
This is a very interesting article. Lots of information. Thank you for sharing. My boyfriend who is 41 was just told that he has 2 heart blockages. He will be doing a 48 hours monitoring test but I am very worry about the meaning of having 2 heart blockages. Accirding to what he told me, 2 out of 3 ventricles are not functioning. He is gain weight, (290 pounds), is very tired and seems to sleep lots. We are waiting for the specialist visit. But mean while, is there anything I can do to help him? Like what type of diet is recommended for people with his type of problem? Thank you in advance. Many blessings your way…
Its not making sense, do you have the echo report.
I just had a stent put into one of my coronary arteries two weeks ago but have another 70 percent blockage that needs to be taken care. My heart doctor is going on a vacation so I can’t have it done until after the 30th of January 2017. What are my chances of having attack before then? I am concerned and am having some chest pain.
I stage procedures commonly, whereby i will fix one artery in an emergency then bring someone back to finish the job. Your cardiologist has determined the blockages to be significant but not critical so the chance of a heart attack isn’t a concern for him/her. If having chest pain however the situation is possibly more urgent, you need to bring it to the attention of the cardiologist and see if the plans need changing.
I’m 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. January 6, 2017 I had an angiogram and they found the LAD 100% blocked and the Doctor couldn’t put in a stent because of the location of the blockage and the hardness of the blockage. The doctor recommended bypass surgery but after his findings there has been no real urgency to fix this problem so is this normal?
I suspect the problem itself has been around a while, it is what we call a chronic total occlusion or CTO. This is why there is no large urgency as it has not developed overnight and i assume you are clinically very stable. When I do CTO’s i schedule them as outpatient, they are in general not unstable patients for that reason mentioned above. . There are 2 approaches, and i cant really comment without seeing the films. One is bypass if the lesion is really not amenable to a stent approach, or the other is a CTO approach whereby a CTO specialist would have an attempt to open up the LAD using ore dedicated techniques. In our center each CTO case is assessed by the interventional cardiologist, the surgeon and the referring cardiologist in whats known as a heart team approach to make sure the best option is chosen on a case by case basis.
This article is really helpful for me but I have a question my dad has 80% blockage in his heart …..And some doctors are saying that it is an urgent need to have an operation ….And also he has chest pain only during night and after he has his meals….and I also want to ask that after how .much time can he have operation that would be safe….???
It depends on how stable he is determined to be. It also depends on the stability of the lesion. If its stable often there is no emergency, however if the lesion is felt to be unstable then this is of course different and an emergency.
Thank you for the illustrations! Very well-written, clear article, explains to me what the dr who did the cath didn’t go into detail about immediately post-cath.
I found your illustrations extremely helpful and am able to understand more clearly the situation my mother is in thanks to this helpful website .
She is in hospital following pneumonia and two subsequent heart attacks. An angiogram yesterday confirmed that the right artery is blocked and inoperable, the circumflex is blocked and inoperable and the LAD is calcified but doing enough to keep the blood pumping. Consultant advising treatment with medication only as she is too unwell for surgery, she is 85 years old. This is pretty gloomy news isn’t it.
Its different in every case and i cant be specific without seeing the pictures and details. A lot depends on the collateral blood supply and the heart function, in some cases these are well developed and intervention is not needed.
Hello dr, my brother he is 30yrs only he had a good healthy lifestyle 2 hours of workout everyday and constant check on his diet too he has been particular about his diet as we have a history of heart problem in our family both side , but yesterday he has been deducted with 80/-!blockage on right and left 70 percent and extreme left 60/- dr has been asked to go for angioplasty for 3 stents can you please suggest us any other way it can be cured
Dr Ahmed I am 67 years old, I passed out while working , left circumflex was block , om1 was blocked , I had the colonoscopy done 2 weeks ago , use PREPOPIK as kit, colonoscopy was done 2 weeks , had epi gastric discomfort with bloating on occasion after the colonoscopy , just before I passed out I had severe gastric discomfort with pain at the bottom ribs radiating to the back , do you think I passed out because of the blockage or gastric discomfort ?. By the way they put 2 stents one in left circumflex an one i om1, I still have gastric discomfort here and there .
I would need to see images and know a lot more to comment. Did you have the blockages fixed before or after the passing out and the colonoscopy? Did the pain change in character after fixing it. I think you need both GI and Cardiology input. If there are concerns about residual blockages then further testing may be needed such as stress testing.
First of all congratulations on this site and the info… a noble cause very well done indeed.
I am 39 years old, male, Around 20 years back i was heavily into sports
I underwent an angiogram last may, 2016 as was having mild intermittent chest pain and TMT was supposedly false positive. The angio was normal but it showed a myocardial bridge in mid LAD causing a 30% systolic narrowing. 3 cardiologists have said its absolutely normal and the chest pain is coz of GERD…. i am on medications for gerd ( ppi’s) and hypertension but the pains dont go away completely. the peculiar part is most of the times the pains starts around evening and continue till night. i was a regular heavysmoker ..now only 1 cigarette a day with morning tea.
1. What do u think my problem is ? ( one cardio believe its mental and has precsribed librax)
2. These percentages that you have mentioned in your article and my report says 30% systolic narowing. are these computer generated or manual ? i mean is it possible that its mentioned as 30% in my case whereas in actual it might be 70% coz of the MB ?
3. For all other arteries the angio report says normal , i mean does it mean its negligible or around 30-40% and hence in cardiac parlance normal ?
The myocardial bridge if truly only 30% is not likely of any significance. The percentages are typically a visual estimate based on experience. Often when there are questions further tests should be performed (such as ff.) often for lesions 50-70% For the other arteries they are likely normal to the eye. In many patients however although it looks normal, and no specific treatment is recommended, there will be disease in the artery wall itself and therefore risk factor control is key.
First of all congratulations on the very brilliant and informative website. A very noble deed well executed.
I am 39 years old, male,. Around 20 years back i was heavily into sports
In May last year i was diagnosed with hypertension and occasional mild chest pain / discomfort. I was sleepless / restless and under stress . Then a TMT which showed some issue at stage 3 and 4. The cardiologist said its false positive. Then an angiogram was done ( basically i forced it) which was normal but it showed a myocardial bridge in mid LAD causing a 30% systolic narrowing. he said its nothing u have lived with this all these years ( also during my athletics days) and its pretty normal.
But i still have the pain sometimes in chest and in the left arm. the pain always starts in the evening and lasts till night. happens in phases 10 days followed by no pain for a month or so and then again comes back.
I saw a gastroentologist also who opined that i am suffering from GERD , did an upper GI endoscopy which was normal except for HPylori infection. Put me on pantoprazole. though things have improved but i still get pain in the chest The gastroenterologist also said since i get anxious always it aggravates the pain and the GERD. The cardiac’s say angio is done and its clear and that is conclusive and gold standard test.
I have started doing exercise and yoga since last 8 months, diet modification, lost around 5 kgs weight cut down smoking to only one per day and very occasional drink maybe once or twice a month. Pls help as i am very confused
1. also wanted to know is there any possibility that the 30% systolic narowing coz of the bridge could be the culprit? i mean how are these percentages determined which you have also quoted in with pictures ( 40%,70%,etc) is it computer determined or manual. i mean is there a chance that in my case it isnt 30% narrowing but 70%. i mean can the angio results be wrong ?
2. also all other arteries and even LAD is normal… normal means < 40% . i mean with all risk factors mitigation can this be controlled at this level and i will never have to be a heart patient ever ?
Dr. Ahmed,
My nephew of 35 years of age was taking to the hospital for heart attack. He had been diagnosed with a blockage of 98% in his artery. The Dr. opened up the blockage with a balloon then placed a stint. The catheter got stuck on the stent and broke off in his heart. This caused another heart attack. He was rushed to another hospital at which time he was told that his artery had died. The Dr’s are unsure what to do. He is in ICU with my Niece frightened not knowing what to expect. Heart Surgery?? Can you advise anything. Any idea of a prognosis. Anything???
Dr. Ahmed,
Update on information previously sent:
The Dr. placed a stent in nephew’s OM coronary and managed to break off the tip of an .014 wire on the stent and the piece remains in that artery. (OM obtuse marginal) – they said the artery has died?? Would a by-pass work??? Please advise.
Thank you so very much for your knowledge and input.
Respectfully.
I would need to see the images to comment accurately. Wires that are stuck in arteries have differing consequences depending on the location. I have been sent these in the past to remove which can often be done without surgery. 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.
Ask the following questions.
What is the pumping function of the heart (>55 is normal)?
Is the damage permanent, is there scar?
Are there any other significant blockages that require treatment?
What is the plan, if any, for the retained wire?
What is the long term prognosis likely to be from the current event?
Trying to send images. no other blockages. Bp all over place 150/98 to 129/90. Dr said putting another cath in the morning to access damages.
having trouble downloading pictures.
I will have my Niece Amy send you the images. She is in the hospital with nephew. Thank you so very much Dr. Almed.
Dr. Ahmed I will need a e-mail address to send images.
Tried numerous times to send images. At myheart.net; heartvalvesurgery.com;
ahmed@heartvalvesurgery,com all to no avail. Can you still assist. Thanks Debi Lee
(nephew – Cyrus) (niece – Amy)
Dr. Ahmed, would you consider seeing Cyrus. The Dr’s were unable to remove cath stuck in artery fearing another heart attack. His Blood pump is 55.
They are at Centennial in Nashville. Would it be ok for Amy to contact you??
Hi, i’d be happy for them to contact my office if i can be of help.
Phyicians typically send me images on Vitalengine.com
Thank you Doctor, I will forward the information. It is so comforting to know that you are out there caring about people. Thank you again.
Hello Dr. Mustafa,
My 75 year old father had coronary angiography with these results-
LM: Distal LM has ulcerated plaque causing 50-60% stenosis, extendint into optium of LCx
LAD: Type III ostail plaquing
Diagnols: Major diagonal has proximal plaquing
LCx: Non dominant, ostial 95-99% stenosis
OMs: Major OM has proximal plaquing
RCA: Dominant, mid RCA has discrete20-30% stenosis
CV ha suggested cardiac bypass. Is it necessary?
Thanks for the information, and the wide range of responses it has gathered. I’ve just been diagnosed with a 99% blockage at the junction of the LAD and the LCA, which can’t be stented. I was surprised by the high %, given that I can still do most things normally, apart form going fast up hill, dancing or running. I’ll be have a bypass in a month or two, so it’s good to get some understanding that this high percentage is not in conflict with my own feeling of my health.
Hi Dr. Ahmed,
My dad is 74, non smoker and in good shape until his last week’s angiography, showing a 100% blockage in his “Proximal RCA” and between 50-70% in his LM … apparently a sever 3VD. He just showed me the picture of the blockades which was scary.
He was released after the procedure and is scheduled to see the specialist next week (we live in Vancouver, Canada). The info in your article was very useful, but to be honest with you, now I am very worried about risk of a major heart attack.
Do you think he should be hospitalized sooner, or we could wait until next week?
Many thanks!
It depends on clinical stability. If there are unstable symptoms such as those rapidly progressive, or those occurring with truly minimal exertion or rest then i would suggest he is observed in a hospital. If stable then the cardiologist may feel a short wait is not an issue depending on the risk determined through the history and the tests performed.
Recently my father done a angiography its result as below
LMCA: NORMAL
LAD: 80% TANDEM STENOSIS IN PROXIMAL & MID SEGMENT
LCX: 90% PROXIMAL STENOSIS
RCA: DOMINANT, 80% LONG, COMPLEX PROXIMAL SEGMENT STENOSIS.
ADVICE: CABG SURGERY.
My physician check the report & he had treat with medicine. Can it be control with medicines. We are worry. We don’t wants go with surgery. Please give your opinion.
CABG is the final solution?
In general, 3 vessel complex disease that is felt to be clearly significant is treated with surgery for appropriate candidates.
Hi there
I was told back in 2015 that I have critical stenosis in the OM branch of the left circumflex.
Without going into huge details here ( which I would like to ) I will keep it short.
They wanted to PCI/Stent me within 2 weeks, but I said no… because one of the many cardiologists that I saw after he angiogram said, that even if this OM branch of the L-Cirflex was 100& blocked nothing out of the ordinary would happen to me, and even 2 professors told me this as well…. so do I go ahead and have a stent? or would it be just as well to leave it how it is? One of the professors that has seen me has said, that just because a vessel is narrowed, that does necessarily mean that there is restricted blood supply, and so a 2nd angiogram with a pressure wire test is needed to make 100% sure…. and even if that does prove that there is a restriction is it worth stenting as like I mentioned, they previously told me that even if it was 100% blocked nothing would happen to me anyway:)) so what do I do? I would appreciate your professional advice.
Firstly, do you have symptoms? Some form of stress testing to see the extent of the significance of the blockage would be recommended.
My dad s having heart block but he never stopped smoking and drinking.. he suffer short of breath sometimes.. wat do these things lead to.. pls give suggestions sir.. it ll be really helpful.
My father went for treadmill test and found positive , further advised to go for autographs. There he was diagnosed with 90% blockage in all the three arteries in angiography . He is having multiple blockages and fussed in deep. He’s diabetic and hypertension as well for almost 10 years. High cholesterol-237, .. doctor days since diabetic patient don’t feel pain. He don’t feel pain or anything but get tired after 2 km of walk. Some cardiologist suggest to continue medication for one n half months and cardiologist surgeon says to go for surgery immediately after seeing the angiography CD.
Sorry Angiography in place of autographs. Typing error. Pls ignore
Its not really possible to comment without seeing the films. I would be happy to review through a platform such as vitalengine.com then look at the films and give my thoughts.
I request you to please advise he is having three vessel diseases.
hi doctor,
my uncle was informed with 70% blockage but he is still unsure that the pain for few seconds on a daily basis is cardiac pain , Pls guide an C T ANGIO has been done.
He most likely needs a form of stress testing next.
I had an agiogram and they found 3 of my arteries blocked 85 %. I exercise 6 days per week, 4 days arobic and 2 days weight. I am not overweight and have no sympthons at all.
They are suggesting open heart surgery, CABG. I am concerned since I have heard that there are many risks, memory loss when they stop your heart, personality changes, long recovery time, the replaced arteries get re clogged quickly.
Can they not do stents ? or is there any thing else that can be done other than open heart surgery ?
Depends a lot on the anatomy, in certain situations bypass is superior to stent placements and vice versa. It also depends on other coexisting medical conditions. Did you have any form of stress testing?
Hi Doctor,
My Grandpa (79 y/o) has had diabetes for about 15 years and we just found out bad news. He has 25% heart function and 43% kidney function and he’s had multiple silent heart attacks. According to his family doctor, there were no signs to suggest this. He went in to see how blocked his heart is and the doctor’s said most of his main arteries are 95% to 100% blocked and his left ventricle is 25% functioning. Luckily his body started using feeder arteries to flow the blood through. The doctor said stents are not an option and likely bypass isn’t either and he’ll have to rely on medication and a change of diet to maintain his condition. Should our family be preparing for the worst? Can a change in diet and medication help him live with this condition for an extended period of time?
Thank you!
I would need to see the images to comment accurately. Did he have any form of stress testing or viability testing? Does he have symptoms? it sounds like he has well developed collaterals however it may be worth seeking a second opinion to ensure there is no surgical or stent option.
Hello , your articles are really helpful. I would like to share some medical reports of my father who experienced Chest pain radiating to left arm in January at rest.He is currently on Clopidogrel, statins, metoprolol. I would be really thankful if you could share your opinion and what treatment should be opted (I’m worried about RCA and high calcium score-424.5)
Blood investigation reports:
Gamma GT- 79
TSH- 5.060
Vitamin B12- 164
Homocysteine- 29.6
Lipid profile:
LDL(mg/dL)- 91
HDL(mg/dL)-35
Triglycerides(mg/dL)-250
VLDL(mg/dL)-23
Carotid IMT: Bilaterally normal
USG whole abdomen report: Grade 1 fatty changes in liver
– Cholelithiasis
CT Coronary Angiography
Findings:
• The coronary ostia are in their normal position.
The coronary anatomy is right dominant.
• LM and Left anterior descending: There is a soft plaque seen extending from the distal left main to the ostium of LAD, causing 40-50% stenosis in distal left main and significant 60-70% stenosis at the ostium of LAD. Multiple fibrocalcific plaques are noted in mid LAD causing diffuse luminal irregularity and mild areas of stenosis.
Distal LAD is normal in course and calibre.
D1 is a tortuous branch and shows minor soft plaque in proximal segment and is enhancing well with contrast.
•Circumflex is thin branch and is normal in course. There is no evidence of stenosis or plaque.
•Obtuse marginal arteries are normal in course and calibre. There is no evidence of plaque stenosis.
•Right Coronary artery: There are multiple tiny calcified plaques seen in proximal, mid and distal RCA. There is a soft plaque seen in mid RCA causing significant 90-95% stenosis seen.
Mild areas of stenosis are seen in proximal and distal RCA. Few non-obstructive calcified plaque are seen in proximal PLV branch; however, it is normal in course and calibre. Cardiac chambers are normal.
Ejection fraction: 64%
Calcium Score: 424.5 (LAD- 64.7 , RCA- 359.8)
• Pericardium is normal
• Aortic Valve and mitral valve appear normal.
No evidence of cusps thickening or calcification seen.
•Aortic root appears normal in dimension.
With known symptoms that are concerning, and high risk CT findings, i would suggest coronary angiography next.
Thanks Dr Ahmed
We have taken tomorrow’s date for angiography.
Hello dr. Very helpful forum. Recently I was diagnosed with a 70% blockage throuhg a TC scan on the Mid LAD, Also I have a postive stress test my cardiologist told me that I need a catheterization but I refuse because the risk. I have no syntoms, I do one hour of excercise every day with no problem,Even in the stress test does not show any symptoms. Can i handle this situation with medicines.
Please I want to know your opinion to take the Best desition.
Thanks
How positive was the stress test?
Hello dr. Thanks for your reply, the Main results of the stress test are:
-Ischemic changes of reperfusion without symptoms are shown.
-Ekg basal: flat T-waves.
-ST Depression on DII, DIII, and aVF, V3 and V4.
-The theoretical oxygen consumption is 53ml/kg/min.
-The work performed represents an energy cost of 15.2 Mets.
-The effort performed equals 106% of the maximum oxygen consumption (Vo2 max).
-Maximum frequency reached during test 202X’, equivalent to 116 ‰ of the maximum frequency for the patient’s age (174x’).
-Duration of the test thirteen minutes.
-Modified index of sarnoff increase 2.6 (double final product in relation to rest).
Thank you again dr. , and Sorry for mi english
To have a balloon angioplasty, how much of your artery has to be blocked? (In %)
In general a blockage would have to be >70% to be considered significant, often in addition to other tests proving the blockage is of significance.
hi Sir your comments are really helpful I am also in an critical condition that my fathers eco report says heart is working only 25% so doctors denies to do angeography and also advise to not to operate he has recently sfferd with a major attack, unable to take decisions. please help
Do you have more specific details.
Hi Sir, My cousin (Age : 41 Yrs) Angiogram report shows RCA occlusion of 95% and 2 more arteries in RCA are having blockage of 35% and 30%. We have planned for surgery. But kindly advice us whether we have to go for open heart or angioplasty.
You advice will help us a lot.
thanks in advance.
Do you have specific details of the cath report? what is the heart function? is he a diabetic?
No, he is non-diabetic.
He has no specific complaints..
He is doing all works. He has done ECG in medical camp. Based on doubt raised in the camp by doctors. He has done Angio which showed RWMA. His angio report showing RCA occulusion. We have a doubt whether we can go for angioplasty or open heart.
thanks sir
Hi Dr Ahmed
I’m 58 years old, and I’ve been diagnosed with 100%blockage of my right coronary artery. I was told the artery was being backfilled and was working that way and it is a very old blockage to heal itself.but looking at the arteries function,it is for filling oxygen enriched blood to the heart not from the heart ,so I’m a bit confused that the backfilling is very usefull and is my heart being filled from the other side. Thanks paul
Hello dr. I have written before about my problem I was diagnosed with a 70% blockage throuhg a TC scan on the Mid LAD, Also I have a postive stress test my cardiologist told me that I need a catheterization but I refuse because the risk. I have no syntoms, I do one hour of excercise every day with no problem,Even in the stress test does not show any symptoms. Can i handle this situation with medicines.
the Main results of the stress test are:
-Ischemic changes of reperfusion without symptoms are shown.
-Ekg basal: flat T-waves.
-ST Depression on DII, DIII, and aVF, V3 and V4.
-The theoretical oxygen consumption is 53ml/kg/min.
-The work performed represents an energy cost of 15.2 Mets.
-The effort performed equals 106% of the maximum oxygen consumption (Vo2 max).
-Maximum frequency reached during test 202X’, equivalent to 116 ‰ of the maximum frequency for the patient’s age (174x’).
-Duration of the test thirteen minutes.
-Modified index of sarnoff increase 2.6 (double final product in relation to rest).
Thanks
Its a difficult situation in that most cardiologists would be hesitant to leave you on medicines alone without catheterization given a positive stress test on the treadmill EKG even though the clinical portion of the test was ok. How positive was the stress test? It may be worth defining the anatomy with catheterization to ensure there are no critical lesions underlying. Medicines are key, however without defining the anatomy there will always be an element of the unknown which is why the cardiologist wants to cath.
Greetings Dr. Mutsafa Ahmed,
Thank you for your time and assistance here. Your replies have been helpful.
I am 53 year old stage 3 colorectal cancer survivor. I had chest pain on my left side, my back and front. My cath revealed blockages of 98 and 90 percent. The doctor added two stents and for a few days I felt great. Then the pains began again I was told to wait a few days as there could be discomfort. The pain continued and got worse. I went back a week before my follow up and the doctor said that I had an additional blockage of 80 % that he did not stent because it was not a major artery. He scheduled another cath but it is about a month away. Does this sound like a long time to wait?
Very difficult to answer without seeing the case and films and knowing the whole picture but i understand why you are worried. I suspect the 80% lesion was stable in nature and therefore not determined to be at immediate risk. It wouldn’t make sense for the 80% lesion to cause worsening symptoms if the 2 most severe lesions were adressed? Another cath in this setting appears a reasonable idea to look at the 2 other stents and also reassess the 80% lesion. Regardless, if your symptoms are worsening or you are concerned you should bring this immediately to the physicians attention and not wait.
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. Mine can be followed at @MustafaAhmedMD
Dear Sir hope You Fine there, Dr sir my Father is in Hospital right now The First heart Attack happened with my Father in 1997 then in same year operated By pass Surgery , after then in 20 6 times Angioplasty now He suffering very hard pain in chest doctors says His heart is 80 percent damaged so can never take relief from this pain . Dear sir my all family is really worried plz Help me and suggest me
Age: 82; Caucasin male.
Quadruple bypass 1992; Stent 2005; another Stent 2008.
Rx Heart Meds: 40mg Lipitor, 6.25mg Coreg 2/day, 10mg Ramipril.
BP ~ 110/65; LDL< 70; HDL ~ 45-50. EF ~ 45-50
Last Dec., passed new cardio CT scan in flying colors.
Just had an angiogram last week:
Right coronary (artery) totally occluded with evidence of left-to-right collaterals.
Saphenous vein graft to OM widely patent.
Left system shows 99% ostial circ(umflex) lesion with evidence of competitive (flow) from vein graft.
Probably a 60% distal left main disease.
Probably a 70% ostial LAD stenosis, and a long, tubular 75% to 80% mid-stenosis, with evidence of competitive flow from the IMA.
A secondary, 90% stenosis in the mid-LAD, just prior to the insertion of the IMA.
Proposed PLAN!
Continued medical therapy.
Consideration towards chronic total occlusion (CTO) procedure (PCI) could be undertaken down the road.
Questions:
Am I not presently likely to have a major heart attack?
If PCI is to be considered/performed, shouldn’t be done now, not later?
To give an accurate opinion i would need to see the films, however the report does give some insight. The artery on the right is totally blocked, but there is some blood supply to the area that is channelled from the left sided vessels which can keep that tissue alive.The main artery on the left is severely blocked but is bypassed. The other artery on the left is severely locked but bypassed also.
The artery on the right is the target for potential CTO in the future, this is a form of blockage that has been totally closed for a while and requires a somewhat complex procedure known as a CTO to open it back up. CTO should only be attempted if medical treatment has failed, as medical treatment can be effective and the CTO does not increase length of life, rather quality if life. Your disease, given the bypass appears stable and the main blockages protected.
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. Mine can be followed at @MustafaAhmedMD
Dr. Mustafa, thanks so much for your reply.
Prior to your reply, I finally had a clinical discussion with my cardiologist about his angiogram report.
With great relief to me, your detailed reply agreed with his analysis of my situation, namely that my condition is stable due to the effectiveness of my by-passes and robust collaterals proximate to the right CA occlusion.
And, medical treatment is showing efficacy, overriding present consideration of PCI of the CTO of the right CA blockage, which in the best of PCI CTO centers remains a relatively risky procedure.
Thanks again for your informed comments,
Jim
P.S. 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.
Best,
Jim
That is excellent and actually more reassuring.
This is very helpful. I was just diagnosed through catherization with 99% and 95% blockages on two main arteries and 3×50% on a third, given a strong family history of atherosclerosis (father died at 45, I’m 57). The response from cardiac surgeons is to schedule an echo in 10 days and then another consult. While I don’t have chronic chest pains, I do have pain with light/moderate exertion. On a 10-point scale, what should be my sense of urgency?
Its of course hard to comment accurately without knowing the clinical picture or seeing the films. I suspect you have stable coronary artery disease that is advanced in nature. Do you have details of the catheterization report and the affected arteries? What is the ejection fraction of the heart? Also are you clinically stable, as in do you have chest pain at rest or any instability?
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. Mine can be followed at @MustafaAhmedMD
My Dr. found a shadow on the left side of my heart. I am suppose to have a heart catch done. If they go through the groin area, which side will they go through? Left or right groin?
Typically people go through the right groin. I personally always take a radial (wrist) approach whenever possible. It is more convenient for the patient and associated with less complications.
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. Mine can be followed at @MustafaAhmedMD
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
Except the doctor said he has an artery running through a muscle but did not explain just said all ok
So why is he waking up at 5 in the morning clutching his chest with pain jaw arm hurts and call 999 they came did an ecg and heart rate had fallen to 34
But all tests fine
What the heck is it ?
Our sons are seeing all of this and are worried sick
Please help
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. Im not sure why he is waking up clutching his test or why his heart rate is low, it seems like further investigation may be required, although its very reassuring that his prior testing was ok. Diagnoses to consider may include spasm of the arteries or other.
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. Mine can be followed at @MustafaAhmedMD
hi my dad has a one valve blockage 80-85% and one valve is small to compare to other doctor suggested open heart operation please any one suggest me without operation how we can recover plz suggest me
Do you have specific details of the test reports.
hi I had done calcium score test and the result reads that I have 0 score. Is it possible that I can still have blockages , I have cholestrol , no bp ho dibetes. Do i have to do angiogram
thank you
Do you have symptoms of chest pain, chest pressure or shortness of breath? If not then your testing appears very reassuring and there is no good indication for an angiogram.
Hi sir, Is it possible for a 21-year-old male to have a heart blockages? Or is there any other reason for a guy this age to have chest pains? Could it be serious? Because Heartattack is in his family history..
Anything is possible, although unlikely, if you are worried, please see a dr for a consultation.
My dad who’s 82 years of age recently had a pacemaker procedure due to low heart rate. He also had an angiogram done and now his doctor is recommending an angioplasty due to Left main coronary artery blockage. Is it really necessary?
His findings:
Left main coronary artery has a 60-70% distal stenosis and bifurcates into the left anterior descending artery and left circumflex artery.
Left anterior descending artery is a good sized vessel with a 50% ostio proximal stenosis and luminal irregularities at the proximal to mid segment but is patent. Diagonal and Septal branches are also patent.
Left circumflex artery is a good sized vessel with a 70% ostio proximal stenosis. The mid to distal segment of the LCx is normal. Marginal branches are also normal.
Right coronary artery is a good sized dominant normal vessel. The RPDA has a 50% ostial stenosis.
I would recommend at least the consultation and/or involvement of a surgeon even if only for back up, opinion and availability. Also, such a case needs to be done by an experienced operator with adequate back up and equipment for a case of this complexity.
If you are interested in cutting edge information and therapy for heart disease then follow my twitter at @MustafaAhmedMD
Do you have further details of the report? do you mean left main or the LAD?
If you are interested in cutting edge information and therapy for heart disease then follow my twitter at @MustafaAhmedMD
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. “
Lad 90% your pictures showed me exactly where my 2.75 by 12.00mmw stent was placed. Thanks
If you are interested in cutting edge information and therapy for heart disease then follow my twitter at @MustafaAhmedMD
I am 23 old, there is heavy ness in my chest above the heart and some time I feel jumping of heart and some time pain (pointed) in the heart with dizziness, calf pain and weakness through the day since 5 to 6 days
Is this heart blockage.
You should be checked out by a medical practitioner and not take a chance.
If you are interested in cutting edge information and therapy for heart disease then follow our twitter at @MustafaAhmedMD
Hi Dr.,
What is the meaning of my CT CORONARY ANGIOGRAM test result below:
FINDINGS:
Coronary arteries
Right coronary dominant circulation seen.
No obvious coronary origin anomalies.
Left Main (LM):
Tiny eccentric calcified plaque seen in distal main left coronary artery just proximal to the trifurcation without causing significant stenosis <20%.
Left coronary ostium is normal.
Left anterior descending artery (LAD):
Type III LAD.
Mixed plaque with calcification seen in the proximal LAD causing significant stenosis of approximately 90% with reasonably good flow distally. No obvious plaque/obstruction seen in distal LAD.
(Beam hardening artifact seen due to calcified plaque which might have caused mild
changes in calculation of percentage of stenosis).
Its diagonal (D1, D2) and septal branches are showing normal contrast opacification.
Left circumflex artery (LCX):
Short course of LAC with prominent obtuse marginal (OM1) artery with no evidence of calcified /hypodense plaque.
Right coronary artery (RCA)
Right coronary artery and its branches are normal with no evidence of stenosis/obstruction. Its posterior descending artery and posterior left ventricular branches, appears free of disease.
Ramus intermedius: Normal study with no evidence of significant stenosis.
Normal enhancement of the myocardium and endocardium.
Visualized sections of thoracic aorta appear normal.
Pulmonary vessels
Pulmonary artery trunk appears normal in diameter with normal opacification. No pulmonary arteries dilatation.
Pericardium
Thin and non-calcified
No definite evidence of pericardial effusion.
Agatston or Coronary calcium score:
Total Calcium Score is 43.8.
Agastons’ score of above 400 is associated with increased risk of coronary artery disease.
IMPRESSION:
Mixed plaque with calcification in the proximal LAD causing significant stenosis of approximately 90% with reasonably good flow in mid and distal LAD.
Tiny eccentric calcified plaque in distal main left coronary artery just proximal to the trifurcation without causing significant stenosis <20%.
(Suggested conventional coronary angiography for further evaluation.)
The scan suggests a severe lesion in the LAD artery. You need to have an opinion from an interventional cardiologist regarding conventional angiography and possible stenting vs. other treatment.
If you are interested in cutting edge information and therapy for heart disease then follow my twitter at @MustafaAhmedMD
Thanks a lot Doctor.
Dr. Ahmad, I had a syncopal event while vacationing overseas. The angiogram done on the 6th of July showed a 100%blocked proximal right coronary. But i was told i had good collaterals.
I continue to have some symptoms of dyspnea, and chest fullness, and the holter monitor showed some PVCs. The Echo is normal except for the mature inferior wall infarct, showing hypokinesia.
I am scheduled for stenting at Barnes Jewish Hospital on the 7th of August. Needless to say I am somewhat nervous. Do you think it is necessary that i have the stenting done? I hope i receive your response soon.
It depends on the procedure being done. Are you having a procedure of the right coronary artery or the left? where are the PVC thought to originate from?
Dr. Ahmed, My dad had an angiogram this morning and I have a diagram showing the blockages. His right coronary artery was 100% blocked and a vein called ‘diag.” branching off the LAD was 90% blocked. There were stents placed in these 2 areas. My question is regarding 3 other areas where he has narrowing that was not fixed during the angiogram. The diagram shows 3 smaller arteries all on the left side, each with 70% blockages. One is a branch of “Cx”, and one is a branch called “SP” off the LAD. Another one is on the left side of the LAD and not labeled. No stents were placed here as I believe they could not be reached with this procedure. Do you know if the only way to fix these is through open heart surgery? Should I be concerned that they are sending him home with these blockages? His ejection fraction is 70% and although he had a heart attack, his tissue is healthy according to the doctors. He is 71 years old so I’m concerned that when these arteries become problems, he may be too unhealthy for surgery. Any info or thoughts you can give me would help. Additionally, my parents live in a remote area and the hospital he is currently in is sending him home which is 4 hours away. Thanks so much!
Hi, obviously i cant reply fully accurately since i cant see the images but ill try give you a little insight. it sounds like his 2 major blockages have been stented and the left rest to be medically managed. The correct approach to coronary disease and intervention as things stand is to only felt lesions felt to be critical, i.e every blockage of 70% doesnt need stenting. This approach is backed by research and is felt to be far superior to the stent everything we see approach. I personally almost always use other tests in the procedure such as IVUS or FFR to guide my decisions as i feel this is much more scientific. The SP is a septal perforator and would never need stenting even if the blockage was 90%. The branch of the Cx is called a marginal and im not sure about the other however it must have been felt to be of mild or moderate significance and left to be medically managed or the artery to small to be considered of significance. Medical management id an excellent option for moderate disease. Medical and lifestyle treatment and attention to risk factors is now critical.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
SIR I AM HEART PETITION. DONE MY PTCA. MY OPERATION DONE LAST SEP 2016.
INSERNING STENT. NOW I AM FEEL BETTER. CAN I JOIN GYM,YOGA. PLEASE GIVE THE ANSWER.
If you have stable coronary artery disease and have been followed by a physician thereafter that allows activity as tolerated then exercise is certainly encouraged. Cardiac rehabilitation programs can be particularly useful.
I am so amazed at your personal response to each person! I have been experiencing breathing issues after or while falling asleep. I wake up grabbing onto whatever I can (pillow, sheet) and gasping. I am only 48, but have family history of heart issues (maternal grandfather died of first heart attack at age 49, aunt died at 56). I brought up these issues to my doctor. She made a face and said she could refer me for a test but doesn’t think it will show that anything is wrong. I am torn as to whether to go ahead with a test, as it is expensive. I don’t have any issues with breathing during the day or when sitting up, only while lying down and sleeping. Thank you!
I forgot to mention diagnosed with tachycardia in my 20’s. Again, thank you.
Basic tests such as an EKG and physical exam should certainly be done. If the symptoms continually recur then an echocardiogram and a sleep study would be reasonable tests to pursue. Certainly they may help to alleviate your concerns.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
Hi Dr.
Please update us whether do we have to go for angioplasty or will it can be cure by homoepathy.
As we have done CAG – Cardiac angiogram in Narayana Hrudayala, Bangalore, India.
According to the report it says something like that
LCX – mid 100%
RCP prox. 80%
K.I. prox 80%
normal sinus rhythm
In general such disease would require intervention such as stents or bypass however i would need to see the films to comment more accurately.
My dad aged 65 yrs, having normal dominant right coronary artery. The LAD has 50 to 70% lesion in the proximal portion. There is 90% lesion in the proximal circumflex.
Can you please advise if angioplasty or bypass is required, or only medicines with controlled diet and exercise would suffice. Please share your valuable advise.
If the LAD is critical and the disease complex then a bypass may be needed particularly since there is a complex lcx lesion. If the disease is less complex wand it is just the lcx or the lad and the lcx can be simply stented they that may be preferred. I would need to see the films to comment accurately. Medicines , diet and exercise will be required regardless. What was adivsed by the treating physician, did you obtain a second opinion?
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
Dear Sir, In 2013 doctor diagnosed that I have 100 % RCA and 40-50% LAD blockages and advised me to take medications. Generally I don’t have any problem, even I can run and walk fast for a long period and I don’t feel anything during exercise, but after exercise around 10 hours later , I am feeling some pain and unrest into my left shoulder and the left side of my chest attached to my shoulder , even while I am resting. What would be the reason of that unexpected pain during the rest? . Regards/ Mohammad Masjidi
Its not typical of chest pain to manifest at that time period after exercise however given your history some form of stress testing may be advised to rule out any significant artery disease progression.
Hello my doctor did an angiogram ns showef a 90% block in LAD he put a stent, did he do the right thing?
If you had an indication such as symptoms or demonstration of risk on stress testing then most likely yes.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
My mom is having 80-90% of stenosis in small caliber vessel.(Type 3). doctor is telling that as its a small caliber vessel stent is not required only medicine will help. Is it stening not required
If the vessel is small and not felt to be supplying a significantly large area then medical therapy is often the more sensible and recommended option.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
My dad has 70℅ blockage in Lad what should we do angioplasty or bypass? And after how longer the blckage again grow after angioplasty? ???? Plsss reply fast plsss
This cant really be answered online in an emergent situation. Depends on many factors and the anatomy.
Thanks doctor i want to know how long a stand keeps the artery open??
Halo Doctor,
Good Morning,
My father(72 age) undergone for CT Scan, Calcium Score was 393.
LCX are 40-50% – Dominant vessel – Eccentric calcified plaques noted within proximal LCX resulting in stenosis. Rest of the LCX shows shows wall irregularity.
Impression of the CT Scan – 40-50% stenosis of proximal LCX
20-30% stenosis of proximal LAD
Kindly suggest me, that any risk factor is high or how to proceed further.
Thanks and Regards,
Ravi Kumar N
Read this article to get a further insight.
https://myheart.net/articles/ct-coronary-artery-calcium-heart-scan-the-facts/
It depends on why the scan was done in the first case as to whether stress testing is advised or not. Regardless risk factors such as diet, exercise, cholesterol, diabetes, smoking, blood pressure etc should be addressed.
………………………………………………………………………………………………………….
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
Halo Doctor,
Good Morning,
Thank you for your response, my father was having chest pain on both the sides, so our doctor prescribed to undergo for CT-CAG, based on the that posted you an query regarding same.
I am very much scared, Please advise is there risk factor or how to reduce the calcium score and how to be healthy from his side.
Thanks and Regards,
Ravi Kumar N
Hi Doctor,
My Dad recently went through angiogram, we came to know that he has 100% blockage on one valve.
As per the report.
LAD: LAD is occluded at ostium, distal vessel is seen iflling via collaterals in RCA shot.
LMCA: Normal & trifurcates.
RAMUS: Proximal 70% stenosis.
LCX:non-dominant, proximal 20% stenosis, OM proximal 60% stenosis.
RCA: Dominant, proximal 20-30% stenosis.
Myocardial perfusion study
INDICATION: ACS-Ev,AWMI, LVEF-46%. T2DM,HTN,CAD-TVD, For LAD Viability.
Protocol: Rest study done with 15 mci of 99m Tc-MIBI administered IV.
Observation: Large perfusion defects are seen in the distal two thirds of the anterior wall, anteroseptal wall, septum, apex and inferoapical walls.
LAD TERRRITORY: Large infarcts are seen in the distal two thirds of the anterior wall, anteroseptal wall, septum, apex and inferoapical walls.
RCA and LCX Territory: Lateral and inferior walls are perfused at rest.
Gated SPECT: LVEF at rest is 41%
Can u please explain me the condition of the report.
Doctor has suggested to continue tablets…
Thanks,
Hema N
He has severe artery disease, with major blockages in several arteries. His heart function is also reduced. His stress test is strongly positive per report. In many cases such people need revascularization through surgery or stents in some cases. I would ask the cardiologist why medical therapy has been preferred in this setting and their thought process. In some cases medical therapy is advised for example frail patients, poor targets for bypass, symptoms etc.
you can follow my twitter at @MustafaAhmedMD
Dear Sir
My father got stent in his heart in right artery at Escort Heart Institute but this artery still 100% blockage they are saying that because of heart attack there are some part had dead in Artery still ECG not coming normal what should i Do
What was the initial advice you were given? what was the rest of the heart report?
Hi Dr Ahmed
how much arteries occlusion affect heart’s conduction system , % number occlusion or again >70% blockage or it is not related ?
i read about spasm in heart tiny vessels and it make chest pain like angina , is this true ?
there is lot of supplement for heart if those products have a true benefit which ingredient you recommend ?
Thank you
Spasm can cause angina in certain cases and there is treatment for this such as calcium channel blockers and nitrates.
I personally don’t recommend supplements as i’m not familiar with them or convinced by them.
Halo Doctor,
I didnt receive any reply for the above ask. My father is suffering from Bronchitis from past 10 years
Plz respond and do the needful.
Thanks and Regards,
Ravi Kumar N
My mother just had angiogram today, found a 30% blocakge. Is that room for major concern?
In general no, not a concern, however should be a trigger to address cardiac risk factors.
you can follow my twitter at @MustafaAhmedMD
Which stent is best doctor for 80% blockage
Hi dr. My mother had symptoms of chest pain, shortening of breath while walking or going upstairs. It was assumed as heart related isssue and angiography was performed which resulted 50% stenosis of proximal LAD blockage. In addition to that hernia in esophagus was also diagnosed. The team of doctors concluded not to put stent and treat the symptoms with medication. But doctors also corealte the symptoms of hernia with heart. How to rule one of these two out to start focusing on the right treatment. They gave her a medicine to control heart burn.
Please advise what shall I do…..
Stents should not be placed in 50% blockages. https://myheart.net/articles/stent-save-life/ Read this article and see if it helps understand the reasoning for this.
you can follow my twitter at @MustafaAhmedMD
Dear Doctor,
I got an cardiac radiogram report saying that having
” LMCA :Normal
LAD :Luminal irregularities+, no significant disease
LCx :Non-dominant. Divides early into 3 moderate sized OMs. I st OM has 60-70% lesion.
Rest has mild lesions
RCA :Dominant; significant mid segment disease ; competitive flow in distal PD seen”
I don’t know what’s happening. What these means. is this case requires angioplasty please recommend what to do?
You have some blockages that are restricting blood flow to some areas of the heart. The need for stenting would depend on multiple factors such as symptoms, heart function, and functional testing. It needs to be evaluated by a specialist who takes all these factors in to account.
Hi Doctor,
Good Morning,
My uncle undergone Angiogram today and diagnosed as Two Vessel Disease. Doctor recommending to go with Angioplasty. Please find reports below. Urging us to quickly progress with the decision.
LMCA: Normal & Bifurcating into LAD and LCX.
LAD: Type III Ostio proximal LAD 95% stenosis. Distal LAD diseased & Thin Vessel
LCX: Co-Dominant. OM1-80% stenosis (less than 2mm vessel)
RCA : Co-Dominant. Proximal to distal RCA diffusely dieseased (non- graftable)
Recommedation: PCI to LAD
Would you please review the above report content and suggest any other alternatives or good option to go with?
Regards
Selva
Its difficult to comment accurately without seeing the images and knowing the case so i would defer to your specialist. It seems from your report that due to the diffusely diseased and relatively small caliber nature of the vessels this is not a candidate for a bypass and therefore a stent to the critical LAD lesion has been advised.
you can follow my twitter at @MustafaAhmedMD
Hi Doctor, I am 45 years & suffering from minor Chest pain (Centre) from last 2 months…
ECG, Echo, Stress Test, CT Scan – Chest every thing is normal.
Any medicine for Muscular , Gastro, Acid Reflex, does not work.
Chest pain is 24X7 with no other indication.
Consult 4 doctors (Cardio)…all say it is not heart related…still can not say what exactly it is.
So, which test should I do to clear that this is not heart related ?
I am 44 years old and before 3 months i experience terrible chest pain and heart attack, really it was painful and i was suggested a Angiogram and doctors suggest me a medication….. my two arteries were infected and 50% damage…. these images really help me
Glad you found them useful.
you can follow my twitter at @MustafaAhmedMD
Hi Dr Mustafa Ahmad .,
My name is Muhammad IKRAM. My father undergone Angiogram at 1st november 2017 and diagnosed as Three Vessel Disease. Please find reports below. Urging us to quickly progress with the decision.
Coronary Angiography Report
FINDINGS:
Indication for Angiography:
DSE +ve
A.O Pressure:
Left Main Stem :
Normal,bifurcating vessel.
Left anterior descending artery (LAD):
Mild proximal and moderate disease at middle part (1.1.1).
D1: Mild ostial disease.
Left circumflex artery (LCX):
Moderate disease at proximal part. OM1: Mild proximal disease.
Right coronary artery (RCA):
80% mid and 80% stenosis at distal part. Ectatic dominant vessel with mild disease at bifurcation.
LV Gram:
Not done.
IMPRESSION:
Triple vessel disease.
Can you please advise if PCI to RCA is required, or only medicines with controlled diet and exercise would suffice. Please share your valuable advise.
Can u please explain me the condition of the report. Please advise what shall I do…..
I am wait your reply.
Thank u….
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 the disease is stable then medical therapy may be enough, if unstable or if medicines do not improve the situation then of course intervention would be recommended. Discuss the case with the treating physician.
you can follow my twitter at @MustafaAhmedMD
Hi Dr Ahmed, I loved your article on blood clots now I have to read the article on cardiac cauterization.I was diagnosed with a blocked artery but don’t know how much it is blocked will find out next week. I hope this is the only one it’s been a very stressful year for me don’t need any more. Thanks for all the info it has been very helpful and interesting .
Hi Dr. Mustafa,
Thanks for precise explanation of heart blockage. This was very useful for me. So, my 65 year old mother had 2 surgery of heart stent so far. She has been taking medicines since has been done surgery on heart. Every year she has medical check up. Unfortunately this time stress test resulted with complete heart blockage. Obviously, doctor says this is normal. But I see, in reality it’s not. Every day she has heart ache. Would you mind please advise if she needs treatment or surgery again?
I would highly appreciate your soonest reply to my email address.
Thanks
The decision depends on several things. Firstly the results of the stress test needs to be clarified. It needs to be determined whether the symptoms are stable or unstable, and it needs to be ensured she is on a optimal medical regimen. This needs to be done by someone who has access to her history and studies.
Great article Dr Ahmed
I have been told I have triple vessel disease with diffuse moderate disease in mid LAD, severe distal LCx and OM2 disease and moderate disease in small proximal RCA.
I have been struggling with breathing of late and most of it due to calcification. Is there anything that can reverse this?
I had a renal transplant over a decade a go and a TIA 3 years ago. I have AF and they have put me on warfarin and Aspirin and caltrate. Will this be worse for the calcification? Is there any alternatives? Thank you
These decisions are complex and should be made on a case by case basis, its difficult to comment also without seeing the films. It sounds like medical therapy has been advised as opposed to intervention due to the nature and location of the disease. In stable patients, medical therapy is a widely accepted option. In terms of reversal, optimal medical therapy,diet, exercise, risk factor modification etc is certainly recommended. The therapy for the AF should not really affect the calcification.
you can follow my twitter at @MustafaAhmedMD
Dr. Is it possible to have a good blood pressure and still have Blockage? I get very weak and break out in clammy sweat with the least exertion. I am 71, I have had triple bypass in 2012, 3 scents since then. I am supposed to have a nuclear stress test on the 20th, I’m worried that I may need to go ahead and go to ER.
If your symptoms are concerning, given your history, go get it checked.
If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD
My friends daughter went to the hospital and they found that her heart had a 98% blockage and wanted to keep her and they said that they would do her bypass surgery in about a week, they said that they wanted to get her thyroid, blood pressure, and cholesterol under control, but she died the next morning, in hospital. Shouldn’t they have done emergency bypass surgery and not waited with a 98% blockage, according to this article it says within a few hours, the sooner the better
Thanks a concerned friend
Sorry to hear about that. Each clinical situation is distinctly different and on occasion it is wise to optimize clinical status prior to operating, particularly if the patient is felt to be stable. This would be determined by the treating team and operating surgeon to optimize the outcome of the operation.
Hi Dr Ahmed, Its very informative article. My mother is 60 yrs old and had recently heart attack. Doctor suggested to do the bypass surgery. below is the report. Is it required to do surgery or medicines will be work.
Indication – CAD AWMI (LYSED) MOD LVD ANGINA
Approach – Right Radial
Dominance – Right
Coronary Angiography
LMCA – 30% lesion in distal segment
LAD – Recanalised.diffusey diseased,osteoproximal to mid 70% to 80% lesion.D1(Major)->50% lesion at osteal segment
LCX – 70% lesion in mid segment.PDA & PLV->normal
IMPRESSION – CORONARY ARTERY DISEASE
LMCAD + TVD
It depends on indications such as syptoms, clinical stability, heart function and anatomy. If he has had the heart attack and has multiple disease vessels including the LAD then surgery may be reasonable.
you can follow my twitter at @MustafaAhmedMD
hi
My father has been diagnosed for NSTEMI, his Echo shows mildly hypokinetic mid septum with LV function EF 54%.
X-ray shows no collection of any fluid. There is no LVF/ Arrhythmia.
Does he need Coronary angiography.
Please advised as soon as it is possible.
Regards
Zia Sayed
Its not safe to advise specific tests in an acute situation over the internet. If he has an acute issue with high risk features investigations are generally recommended and needs to be discussed with his acute provider.
Hi Dr,
My mother had 90% blockage in LAD and 90% blockage in D1. Also 90% blockage in RCA which is nondominant. Also about 60% block in the small branch of LCX. First, she went thought stenting in LAD which got occluded with 90% stenosis at the entry of stent and 90% mid-stent stenosis within 6 months. Then they adviced bypass with LIMA giving supply to LAD and D1. But Dr. said they won’t do bypass pf RCA as its nondominant and RCA has tendency to create its own bypass. I was not satisfied with the answer and been trying to find some medical literature about the issue but can’t find proper information. What do you suggest Dr. Mustafa ? I am wondering if they are already cutting the chest then why not to tackle all issue they can…?
Its difficult to comment without knowing the situation and seeing the films so it limits my interpretation. In general the critical graft here would be the LIMA to LAD and optimal medical treatment. If the RCA is truly non dominant it may be appropriate not to graft this.
you can follow my twitter at @MustafaAhmedMD
My father undergone an angiography today..
Dr said there is around 70% blockage in his two arteries… is it necessary for him to undergo angioplasty or it can b recovered by medication nd following a proper diet..
Depends on many factors such as risk of the situation, symptoms and stability. In many situations where the disease is stable despite blockages, it is reasonable to try medicines first.
you can follow my twitter at @MustafaAhmedMD
hi. My husband is 37 years – high cholesterol all his life, high blood pressure (he’s oin medication for both). He recently had a cardic cath which shows:
Left anterior descending artery 60 stenosis with fractional flow
first diagonal branch 60% stenosis
first marginal branch occluded
second marginal branch 60% plaque
distal right coronary 90% diffuse disease
overall estimated ejection fraction 55%
that said, they gave us two options: stent or open bypass. HIs surgeon said an open bypass or stent on the 60% is easy and doable. However, the issue is with the branch. However, re: the 90%, they could do a stent but because it’s a longer and narrower, the risks for stent closing/blocking up again are greater. But at the same time, the surgeon mentioned he cant tell from the cath is he could definitely bypass it – he would have to open him up before he can decide.
We are bit concerned with the following: an open bypass is clearly a riskier surgery than a stent. We would prefer the stent than to go through the surgery especially if only one bypass can be done. The surgeon believes a bypass would be better if he could for sure do a double vs. opening him up just for one (where a stent could also be in place) but can’t guarantee us anything. Based on the above diagnosis, do you have any opinion? He’s so young to have to go through a bypass and we are just trying to make the best decision with our options. Any feedback would be welcomed. Thank you!!
Disclaimer is: Its not really realistic/appropriate for me to give an informed opinion without knowing the case in detail or seeing the films so defer to the treating team you choose.
The decision in such cases where there is debate about surgery vs. stenting depends on a heart team approach. I see these cases often and ensure both I and the surgeon are on the same page regarding pro and con of each and whats best for the patient. He is only 37, so its important to get the decision right.
With regards to surgery, I will go with surgery if the disease is complex and involves significant LAD disease so a LIMA graft can be used. If the LIMA isn’t used then surgery benefit becomes questionable. If the disease is diffuse, involves the LAD, and calcified with a high complexity with diabetes and poor heart function for example then surgery would be advised. 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.
you can follow my twitter at @MustafaAhmedMD
Hi Doctor,
My Father 69 years old and below are his Angiogram Report details. Doctor suggested for Stunt, but we wanted to take 2nd Opinion to go for any Medicine instead of Stunt.
Pressure Data :
AO: 160/70 mmHg
HR: 80pm
Coronary Angiogram Report:
LMCA : Normal
LAD : Type 3 Vessel, Mid LAD has 80% disease involving origin of large D1.
Diagonals : D1 fair sized vessel and has 50% disease.
Intermediate: —–
LCX : Large Vessel, has mild disease.
Marginals: Major OM has Mild disease.
RCA : Dominant vessel, mid mild disease.
PDA/PLV: Normal
Final Diagnosis: Chronic stable angina, Unstable Angina
CAD: Severe LAD & Diagonal(Bifurcation disease)
Recommendations : PTCA to LAD & D1.
This is the complete report given by doctor. As per ECO report his Heart performance is good and its mentioned 60%. (NORMAL LV FUNCTION – LVEF 60%).
It all comes down to risk profile and symptoms. I cannot advise a treatment regimen without seeing someone or evaluating the full picture of course. If symptoms are unstable then typically intervention is advised. If symptoms are stable then it depends on the risk profile. If the risk is felt to be high or symptoms prominent despite medicines then intervention usually advised. In many cases of stable disease it is reasonable for medicines to be tried to see if symptoms can be controlled.
you can follow my twitter at @MustafaAhmedMD
Hello sir my father had a chest pain and when he underwent checkup found that he has 4 blockage one 100% and other 70% A’s then I was informed by doctors they had done stent for only one blockage which was done and asked for observation for 48 hours. He told us that the other can be done after 48hours or we can do whenever or wherever we want.. I want to also add that he is diabetic. I want suggestions that if he should undergo stents after 48hours or not…I also want to ask if surgery has to be done or stent is good for 3 more blockage??
KIND REQUEST THAT PLEASE REPLY SOON (AS SOON AS POSSIBLE )
This decision regarding the need for any further surgery should be made by the treating physician. A lot of factors are included in the decision including how stable the patient is and how stable the blockage is. Also the location of the blockage and the seriousness of it will weigh into the decision. Often if the unstable blockage has been treated the treatment of the other lesions can occur at a later date or that can be further tests to determine whether they need treating or not and what kind of treatment they need.
you can follow my twitter at @MustafaAhmedMD
hi Doc,
– was always working out, etc.
– got breathless on a few occasions, went testing
– got a stress test, came positive
– did an angiograph – the result was 30% blockage in two places in the lad- showed the report to two more docs, one said 50% the other said 30%
– now, have completely given up milk and products, haven’t been smoking for 10 years, don’t drink
– cholectrol was 214 when this happened(151ldl, 39hdl, 15 vldl). tri – 100
– bought it down to 150(100ldl, 32hdl(I know not good), 15ldl) tri 140 – this went up
– was also asked by a gp to take sera flow 250(inhaler) for maybe asthma
– now, lost 6 kgs in one month due to the diet(76.7 kgs to 71.6 kgs)
– after a month started working out again. though don’t feel 100% as before
– now, symptoms on and off – left calf pain at times, left chest next to berast bne pain at times, tought breathing at times, once post working out was tight over all in the chest, once in a while have pain in left chet with pain in back next to scapula, etc.
– taking choplodogrel/clopilet 75
– don’t take chol lowering drugs as side effects was huge – pain all over, etc
– I’m 42, have been working out, swimming competitively, etc for over 25 years,
– 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
– what do I do – can I reverse this?
– doctors here say symptoms not due to blockage
– theres more, cant write all
few more points:
– bp was always 120/80 as monitored regularly
– post incedent – went down to 110/68 for a while, now hovers around 118/78 or so
– sugar 85 pp, 115 post
I am 52 year old woman, I have a family history of heart problems mother died sudden heart attack, my sister had 3 stents at 45, I have been suffering from chest pain and left arm pain, had calcium score of 17 and also stress test and ct contrary angiogram minor cononary disease. I had a conventional coronary angiogram which showed mild to moderate irregularities in mid LAD I have been put on astrovstatin and told that I not to worry, I am still getting symptoms but doctor says he dose not think it’s related to my heart,should I be worried about finding especially given my family history, I feel like I am a ticking t8me bomb any advice
Hi Dr. Ahmed,
Please give me your opinion on this,
My dad has 100% blockade on Right Coronary Artery,
Left Main Artery is clean and fine,
and also has 100% blockade on Left Circumflex Artery.
The doctors gave him some medication and told him that there’s no necessary surgery at this moment, it would be check again after 3 months.
I’m very concern, please give me your advice.
Best Regards,
Goce
It’s difficult to be able to provide any form of comment without seeing the images themselves. Maybe meet with the treating physician and ask to go through the images and the significance of the blockages. Of course medical treatment and evaluation and risk factor treatment is critical here. Whether further treatment after that is required or not depends on many factors such as disease stability, viability of the heart muscle, heart function and suitability for any interventions, symptoms and disease stability. They should all be discussed with the treating physician.
you can follow my twitter at @MustafaAhmedMD
hi Doc,
– was always working out, etc.
– got breathless on a few occasions, went testing
– got a stress test, came positive
– did an angiograph – the result was 30% blockage in two places in the lad- showed the report to two more docs, one said 50% the other said 30%
– now, have completely given up milk and products, haven’t been smoking for 10 years, don’t drink
– cholectrol was 214 when this happened(151ldl, 39hdl, 15 vldl). tri – 100
– bought it down to 150(100ldl, 32hdl(I know not good), 15ldl) tri 140 – this went up
– was also asked by a gp to take sera flow 250(inhaler) for maybe asthma
– now, lost 6 kgs in one month due to the diet(76.7 kgs to 71.6 kgs)
– after a month started working out again. though don’t feel 100% as before
– now, symptoms on and off – left calf pain at times, left chest next to berast bne pain at times, tought breathing at times, once post working out was tight over all in the chest, once in a while have pain in left chet with pain in back next to scapula, etc.
– taking choplodogrel/clopilet 75
– don’t take chol lowering drugs as side effects was huge – pain all over, etc
– I’m 42, have been working out, swimming competitively, etc for over 25 years,
– 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
– what do I do – can I reverse this?
– doctors here say symptoms not due to blockage
– theres more, cant write all
few more points:
– bp was always 120/80 as monitored regularly
– post incedent – went down to 110/68 for a while, now hovers around 118/78 or so
– sugar 85 pp, 115 post
POSTING 2ND TIME
also,
– they found in a 2d echo a mitrial valve prolapse stage 1. said ignore
Your blockages are relatively mild and almost certainly not in isolation leading to symptoms. You have moderate coronary artery disease and the treatment is medical management. 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. You are already doing what needs to be done.
you can follow my twitter at @MustafaAhmedMD
hi doc,
thank you for your response, pls note:
– what do you mean by – certainly not in isolation?
– last month or so my hr jumps at times.
– normally it was 45- 50 resting/sleeping – now attimes 55 – 60
– walking normally was 80 or so, now at times – 95 to 120 on afew occasions
– when stressed due to work get tight in the chest and find it difficult to breathe
IS THERE A WAY TO REVERSE THIS?
DONT LIKE IT ANYMORE/AT ALL
thanks/
I had a heart attack just over a month ago. I am a 40yo man, in great physical shape, exercise regularly, eat right, etc. I’m currently being monitored for the possibility of atrial flutter or fibrillation.
My question. I was informed that I had no damage to the heart muscle from the heart attack, is that uncommon? According to the notes from my angioplasty my RCA was 95% blocked and I had a TIMI flow of 3.
TIMI flow of 3 means the flow was good. It is possible to have preserved heart function with a heart attack if treated in a timely manner.
you can follow my twitter at @MustafaAhmedMD
Hi Dr. Ahmed,
I am diabetic with HbA1C 7.0. BP is always normal. Total Choesterol 110, Trig 68, HDL 40, LDL 75, Echo-cardiogram (EF 75%) and Stress TMT both came normal. I dont have chest pain or angina. Walk (though slow pace) 2 hours daily without fail . Climb 10 floors of my building without losing breath and no sweating. However, CT Angiogram results came as follows:-
Impressions:
• Calcium score of 883 represents the 90% percentile of the population based on age and gender.
• Multifocal high grade stenosis/occlusion at proximal RCA.
• Significant/high grade stenosis at proximal LAD.
• Significant stenosis at proximal LCX.
• Significant stenosis at proximal ramus branch.
(Stenosis grade: Mild = 70%)
I also got 3D Cardiovascular Cartography done which showed blood flow is normal and Total Myocardial Burden is 0 (zero)
I consulted two Cardiologists. Both said I have Triple Vessel Disease and need Bypass or Angioplasty.
I am your follower on Twitter and have been following your replies here which are very helpful. I request your guidance if I am right candidate for surgery ?
Thanks
Doctor,
I have a significant family risk of CAD and have been followed by a cardiologist for many years for that reason. About four years ago I had a stress test at age 58. A goal exceeding 100% heart rate was reached (120% of goal), and there were no findings at rest or on exertion.
Recently at almost age 62, I repeated the stress test. I later learned from the report that the test was ended at 84% of HR goal (both were treadmill tests). I was not experiencing any unusual discomfort and was surprised at the time when the test was ended since I was not anywhere near the level of exertion as I was during the previous test, four years prior. I have never experienced chest pain during any day-to-day moderate to strenuous activities, although I am mostly sedentary and obese (no other risk factors). The second test was conducted through a different cardiologist group from the previous test.
I am mostly curious what an explanation might be for the first stress test having been conducted so much more aggressively (120% of HR goal) vs. the second test (84%). Would the findings possibly not even have appeared if the second test achieved at least 100% of goal or higher?
Findings were mild to moderate ischemia in Mid Inferior, Basal Inferolateral, and Mid Inferolateral regions. No ischemia at rest. Of course this infers that (70% +) blockages are potentially present. The recommendation is to cath/possibly stent.
Also, I am very much contemplating the issue whether or not to stent if there is an aggressive medication and life-style option. Considering these findings and their severity, is there any information, not advice of course, that you can offer?
Thank you very kindly
Hi Doctor, I am 63 years old, diabetic and high BP. My CT calcium score for LAD was 401. But the angiogram showed LAD was clear and RCA had 85% blockage. A Stent was placed in the RCA. My question – if CT scan showed LAD having a calcium score of 401, how come the angiogram showed it to be clear ?
The calcium score isn’t a measure of vessel luminal compromise.
you can follow my twitter at @MustafaAhmedMD
Have a moderately blocked 6 year old stent..failed EKG and chem stress test..angio on the 15th..going thru my wrist?!?!? First heart attack on 49rh birthday .having angio 5 days bf my 55 birthday/heartattackiversary
My diabetic grandmother has a 90% blockage. They’re talking immediate surgery and asking about a dnr. What is the chance of survival?
Hi,
My Father Went for TMT test and the report was tmt mildly positive inducible ischemia Does Angioplasty is Required for this?
Not necessarily. Medical therapy may be a good option. This should be discussed with the treating specialist.
Hello Dr I hope you can help me understand what is happening with my Youngest Sister …This all started with swollen ankles and becoming very tired and short of breath !! RONA is 64 yrs Old she is overweight does no exercise a smoker Big Meat Eater and although she is adorable and we all love her to bits She is very lazy !!! Her cholesterol is very high reading around 10 to my 4:3 !! She smoked from the age of 15 to 60 and now uses one of those e cigarettes she never puts this down even taking it to bed puffing away through the night ! She has today received a letter from a scan she had two weeks ago …it states …..Prognosis Of Coranary Decease affecting the mid to distal LAD and Mid Proximal third of The right coranary artery …
She read this out to me over the phone , I don’t understand any of this Can you please help me to understand if this is a serious illness as my Sister tends to exaggerate and is always playing at being ill Our Father died of a Heart attack in his late sixties …he suffered heart attacks from his 30 s onwards he had a triple then a quadruple bypass at Basildon Hospital stripping the vains from his legs he was very poorly …I would truly appreciate your reply as I live away from my family I live in Essex whilst all my family are still living back in Liverpool …
Thank you so much
What was the scan she had? Why did she have it? Does she have symptoms? these are the critical questions.
you can follow my twitter at @MustafaAhmedMD
Sir, I need your suggestion. My father aging 61yrs was undergone open heart surgery in 2008. Approximately, 4 blocks were found and were removed successfully. Now two days back CT coronory angiogram was taken on the suggestion a doctor at NIMS, Hyderabad. I herewith produce you the report given.
CT CORONARY ANGIOGRAM
Technique:
CT Coronary angiogram was performed on Light Speed VCT- 64 Slice MDCT
Scanner, with IV infusion of 85 ml of non-ionic contrast.
Reason for examination: Family history of CAD. DM & HTN+. TMT positive.
Grafts:
LIMA –> Distal LAD graft.
SVG –> D1 graft.
SVG –> OM3 graft.
SVG –> RCA branch graft.
Heart rate during acquisition: 55 – 58 BPM.
Normal sinus rhythm could be noted during the entire study.
No adverse reactions to the contrast were encountered.
Findings:
Coronary calcium score (Agastson): 538.
(LAD – 203, LCX – 285, RCA – 40, OM1 – 3, OM2 – 7).
Indicates high risk for atherosclerotic CAD.
LMCA : Normal in calibre, no plaques.
LAD : Type – III vessel.
LIMA –> distal LAD graft with normal anastamotic site and good contrast
opacification in distal LAD.
Diffuse disease in proximal, mid segments causing mild to moderate stenosis
(maximum of 60 – 70%) with focal area of near total occlusion.
Tiny calcific plaque noted in distal segment causing minimal to mild stenosis.
D1 : Normal in calibre.
Eccentric mixed plaques noted causing mild stenosis.
SVG –> D1 graft with mild disease at anastamosis and normal vessel distally.
LCX : Dominant. Normal in calibre.
Eccentric mixed plaques noted causing mild to moderate stenosis (maximum of 60 –
70%).
Patient Name: Mr. D S S SANKARA RAO
Age/Gender : 61 years / Male
Ref. Dr. : jyotsna
Req No : 8482
Req Date : 08 Mar 2018 05:22 PM
Reported On : 09 Mar 2018 03:32 PM
OM1 : Normal in calibre.
Eccentric calcific plaque noted causing minimal stenosis.
OM2 : Normal in calibre.
Eccentric calcific plaque noted causing mild stenosis.
OM3 : Normal in calibre.
SVG –> OM3 graft with normal anastamotic site and good contrast opacification of
vessel distal to it.
RCA : Reduced in calibre.
Eccentric calcific plaques noted in proximal segment causing mild stenosis.
SVG –> RCA branch graft noted with mild disease in the graft. Anastamotic side is
normal.
LPDA & LPLVB : Small in calibre, no plaques.
IMPRESSION:
* Left dominant system.
* Coronary calcium score of 538, indicates high risk for atherosclerotic
CAD.
* Status post CABG.
* LIMA –> distal LAD graft with normal anastamotic site and good contrast
opacification in distal LAD.
* SVG –> D1 graft with mild disease at anastamosis and normal vessel
distally.
* SVG –> OM3 graft with normal anastamotic site and good contrast
opacification of vessel distal to it.
* SVG –> RCA branch graft with mild disease in the graft.
* Diffuse disease in proximal, mid LAD causing mild to moderate stenosis
(maximum of 60 – 70%) with focal area of near total occlusion.
* Tiny calcific plaque in distal LAD causing minimal to mild stenosis.
* Eccentric mixed plaques in D1 causing mild stenosis.
Patient Name: Mr. D S S SANKARA RAO
Age/Gender : 61 years / Male
Ref. Dr. : jyotsna
Req No : 8482
Req Date : 08 Mar 2018 05:22 PM
Reported On : 09 Mar 2018 03:32 PM
* Eccentric mixed plaques in LCX causing mild to moderate stenosis
(maximum of 60 – 70%).
* Eccentric calcific plaque in OM1 causing minimal stenosis.
* Eccentric calcific plaque in OM2 causing mild stenosis.
* Eccentric calcific plaques in proximal RCA causing mild stenosis.
Stenosis quantification is as follows: Coronary calcium score is as follows:
1. Mild : 26 – 50%. 1. Score of 11 to 100 – Moderate risk.
2. Moderate : 51 – 70%. 2. Score of 101 to 400 – Moderately high risk.
3. Severe : 71 – 99%. 3. Score of > 400 – High risk.
I cant understand the technical words inside. So, I may please be explained the situation of my father and what have to be done according to report. Will be waiting for your reply sir.
The bypass grafts appear to be widely patent meaning the bypasses appear to be working. Have you discussed these findings with the treating cardiologist in the context of the symptoms for which the test was ordered.
Hello Dr. Ahmed,
I am a 64 year old male who had an MI in November 2017. Upon presentation to the ER, a stent was placed on an emergency basis in my left anterior descending artery. After the procedure, I went into cardiogenic shock which resulted in acute kidney failure. The cath report also revealed a 95% narrowing of the mid right coronary followed by a 70% narrowing further distally. Neither RAD blockages were addressed. I am doing fairly well now on meds but experience occasional mild angina with moderate exercise. One cardiologist has recommended that I have stents placed in my right artery. A second cardiologist believes that my condition can be managed with optimization of medications, and that the literature indicates that stenting will not, on average, extend life or reduce risk of subsequent heart attack. He also mentioned that research suggests that stents may not actually reduce angina pain relative to a placebo group. Despite the input from the second cardiologist, I am concerned that the 95% blockage can lead to a subsequent heart attack or that it might compromise my heart health going forward. However, I am also mindful of possible complications from an unnecessary procedure, given that the literature is beginning to show that stenting may not be as helpful as previously believed.
I’m curious if you have any thoughts on the matter of whether or not to undergo stenting. I’m particularly interested in knowing (a) whether there is evidence that getting the stent/s might prevent heart remodeling, and (b) whether there is any urgency to having the stents placed.
Sincerely
Good questions.
Firstly, a lot currently depends on the stability of the symptoms. If the disease is felt to be stable the question is much different. If unstable i.e ongoing unstable symptoms etc then the answer is something likely needs doing, that can be determined by the treating cardiologist. In your case the initial presentation was certainly unstable and at this time may be stable. If the symptoms are stable then may make the argument that medical management may suffice. Also taken in to account may be the results of stress testing and such that may determine are at risk. In your situation many may look to stress type testing to help further risk stratify and determine next treatment step. The debate regarding treatment of stable angina is raging and hopefully trials in the next few years will help settle the issue although as things stand no one side can say they are right with certainty. Stenting should certainly only be used when there is a good rationale and thought process. If your disease is truly stable then there is likely no urgency. I suggest you discuss risk stratification testing, symptom status and disease stability with your treatment team.
you can follow my twitter at @MustafaAhmedMD
Hello sir
I need some information my mother have diabetic patient and high B.P problem some days she asking me my left side is highly pain
Dr said me Angiography nd he take angiography and he asked me 2 blocking in heart arteries
1 : RCA = Dominant vessel having mild mid disease with 40% stenosis before the crux
2 :LV Angiogram = Good LV systolic function with 60% EF
Management
Medical management with risk factor modifications
Dr not suggest me stent he aske me only take medicine and raleef this blocking
Please confirm me its right or not suggest me
If the details provided are correct and the evaluating dr is confident then it seems appropriate that medical management for non obstructive disease is recommended. There is nothing reported there to stent.
you can follow my twitter at @MustafaAhmedMD
My husband found out 4 weeks ago he was in heart failure after he went to the ER with severe shortness of breath. They had to remove fluid from his lungs 3 times during his 4 day hospital stay and was sent home with a life vest with defibrillator and several heart meds. My husband has always been very active in sports, not over weight and never smoked. He does have type 2 diabetes in which he takes a oral med for. He was told in the hospital he had weak kidneys also. Then 3 weeks later after getting results back from a modified stress test they scheduled a heart cath. They found he had too much blockage throughout the heart and could not have stent or bypass. They referred him to St Vincent’s Hospital in Indianapolis, IN to see if they could do anything for him or check on a heart transplant. We are waiting for an apt to St Vincent Hospital. Any help would be appreciated-he is only 57 years old and has family history on both sides of heart disease.
Hi Ahmed,
My father who is 61 years old underwent treadmill test where it showed positive.Then the doctor recommended angiogram. The output of the angiogram came out as 60% blockage in the right artery.And then they have suggested us medicines for this without going for stent.how long do we have to continue the medication.is the blocakge reversable?kindky answer this question.waiting fir your reply.
The medication will likely be lifelong and can help stabilize the disease.
How long does it takes for a 70 percent block artery take to be 75 percent
It may never go to 75%, medical treatment and disease stability is the goal.
you can follow my twitter at @MustafaAhmedMD
Hi Dr, my friend is 67, male and has had a mild MI earlier inthe year. He is is a US citizen, but is in Malaysia on business, where he had the MI in Jan. He saw his doctor there yesterday and had some tests that revealed that he had an 81% blockage in one of the coronary arteries and recommended he have
Treatment for this ASAP. The only prob is they want $18k up front. He does have insurance inthe US, however. He does not have $18k to pay up front. Is it relatively safe
for him to return home for the procedure?
Not really possible to answer his exact scenario online since it needs direct evaluation. In general though the answer would depend on the stability of the disease. If unstable likely not safe to travel. If stable disease then likely safe. I would suggest he seek a second opinion if he is uncertain.
you can follow my twitter at @MustafaAhmedMD
Hello Dr Ahmed,
hope you are i good health,
I am 25 years old, not married and located in India and i have recently faced heavy chest pain and vomiting due to which i was hospitalized it was not the first time since in past i have faced the same situation twice. but it was not that much severe till date even i got some gastric issues with me, so i thought it would be gas pain took some medicine and I was all right in the past cases, but recent once was more painful and my ECG was done and reports were not normal same goes to the ECO Report showing mild LV systolic Dysfunction EF 43%….on the above report my angiography was done in march and final report displayed (single vessel diseases) LAD showing proximately 20% plaque (all other vessel normal). I was discharged on medical management next day.
I will be glad if you can suggest me, either I should cross check my diagnosis report weather it is blockage or pressure created on vessel due to gas?…since that day I am not feeling okay with my stomach too.
I was a smoker(no more since last year 2017 september) used to go for jogging twice a week, gym guy (4 days a week morining time)…..My family background is positive (lost my father due to heart attack and my mom have heart issues) currently working in a MNC 9 hours job, 5 days a week (stress full job) my medication allocated to me are CLOPIVAS AP 75 MG (once daily) Atorva 40mg tab (once daily) Flavedon MR (twice daily) and Metolar (once daily).
How severe is my condition? How I can reverse it ? at age of 25 this scenario is quite depressing for me. Please suggest me some tips to avoid increment in plaque and your views if we can reverse the process.
You have LV dysfunction that is mild and no significant obstructive coronary artery disease. Is the LV down in only one area or the whole chamber in generaL. Your medications seem appropriate and your heart function should be checked again in a few months to assess response and recovery.
you can follow my twitter at @MustafaAhmedMD
I have undergone Myocardial perfusion test 10 days before , I just came to know that after the test, for 24 Hrs to 48 Hrs the patient has to take more fluid to flush out the radioactive material ,but I was not instructed to do so.
Is that anything I need to do now to protect myself.
Shouldnt be an issue.
I had got ETT two times that were negative. ECO was normal. Angiography was perfromed as the folllwing comments Right Cornary : Non-dominant vessel normal
Left Cornary : Dominant vessel , Mild irregularities OM-I shows tight ostial stenosis. Small sized branch of distal OM Shows tight ostial stenosis
I feel chest tightness after meals like heavy weight on chest always but never heartpain. However, When i walk (exert) briskly the tightness vanishes gradually as i walk faster.
Hi Doctor,
Today my dad (73 years old) done echo , blood test and ECG – results were negative. His doctor suggested him go for TMT as well for clear his doubts and the result he got positive. Now doctor had asked him to come in the morning for engiography since you have blockage . Please provide me your valuable advise , 1. Can we confirm the blockage with TMT Test? 2. if Yes or No in both cases, what would you advise?
It depends on many factors. In terms of the TMT, we would have to see the tracings to comment. A lot depends on the clinical picture, why the test is done on the first place and whether the symptoms are stable or unstable.
you can follow my twitter at @MustafaAhmedMD
Hello doctor:
Recently during routine health check, TMT was aborted at 4 minutes because of chest pain. 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. Echo normal, normal LV systolic function, PDA diffuse plaquing and PLV plaquing. Does my condition require bypass surgery or can be treated with medicines. If surgery is must can I opt for minimally invasive MICS-CABG
Hello doctor:
Recently during routine health check, TMT was aborted at 4 minutes because of chest pain. 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. Echo normal, normal LV systolic function, PDA diffuse plaquing and PLV plaquing. Does my condition require bypass surgery or can be treated with medicines. If surgery is must can I opt for minimally invasive MICS-CABG. I am not diabetic (FBS-100, PPBS-105), I am not obese (height:172 cm, weight: 60kg). I am a vegetarian, teetotaler, non-smoker.
This is not a question that can be answered in totality over such a forum.
A lot depends on why the test was done and the nature of the lesions that can only be commented on by looking at the films. If the RCA is also to be treated then minimally invasive is not likely an option unless a hybrid approach is taken.
I can send you the films and also all other reports. If you are available in Bangalore, I can also meet you personally and discuss the reports. Otherwise, please advise me how to send the films to you,
Following is a detailed description of my case:
1. Age: 61 years, Height: 172 cm, Weight: 60 kg. I am not obese but of lean constitution.
2. I have led a physically active life and have been walking daily for 45 minutes to 1 hour for several years.
3. I have been hypertensive for many years. However, my BP is under control with Coversyl Plus tablet 1 per day (perindopril 4 mg + indapamide 1.25 mg) and current reading is 130/80.
4. I am not diabetic. Also, I am otherwise quite healthy. As per latest blood reports, FBS – 100, PPBS – 105, Hb – 13.7, RBC – 4.59, Total Count – 6.9, Serum creatinine – 0.8, total cholesterol – 219, HDL cholesterol – 43, LDL cholesterol – 141, Triglycerides 97, all other blood parameters well within normal limits. This was before I started the medicines mentioned below. I therefore expect cholesterol may be still lower now.
5. I do not have any other illness and have never been hospitalized.
6. In March this year, I went for a routine health check. As TMT showed some variations, I was advised to undergo angiogram.
7. Before the angio, echo was done. Echo report is here: https://drive.google.com/open?id=1UHKAlyPkHh6X2UGQJ4yiRDPh8ErD9n10
8. Angiogram was done on 11/Apr. Angio films are here: https://drive.google.com/open?id=1aKO1FA3TniorzyKhTWJeOCgATH6Aq6fm.
9. I have no symptoms while at rest but develop chest pain if i walk briskly for about 10 minutes.
10. I have been taking Coversyl Plus (1 per day) for many years. In addition to this, I am also taking the following medicines for the last one month (that is, after my master health check):
– ECOSPORIN (Aspirin) 75 mg 0 – 1 – 0
– DEPLATT (Clopidogrel) 75 mg 1 – 0 – 0
– TONACT (Atorvastatin) 40 mg 0 – 0 – 1
– STARPRESS XL (Metoprolol) 25 mg 1 – 0 – 0
– NIKORAN (Nikorandil) 5 mg 1 – 0 – 1
12. I have been advised that (a) for my condition, purely medical therapy can only be considered if the person leads a retired life and is not advisable for one like me who is employed and has an active life, (b) stenting is not the best treatment in my case as I will need four stents and chance of failure is high, (c) bypass surgery is the best solution.
Further, for the surgery, it has been suggested that I can opt for Minimally Invasive Surgery (MICS-CABG) which will give the same or better results compared to conventional bypass surgery. But there are conflicting opinions on this.
13. I need advice on these questions:
– Is it possible to avoid surgery at all (either by medical therapy or with stenting)?
– If surgery is unavoidable, can I opt for MICS-CABG? Is this as effective and as complete a solution as conventional bypass surgery?
If a surgical approach is taken, my advice is not to dwell on a minimally invasive approach vs. open rather go the the most experienced place with the best outcomes, the most ethical reputation and the place you are most comfortable with and let them decide.
Sir,
Recently I have done CT angiography with the advice of my family doctor and the report says some blockages. When I met a cardiologist, he said, this CT angiography is not enough to accurately suggest the blockage conditions. So he advised me to go for Catheter Angiography. Now question arises, if CT angiography is not accurate, then why this test is done widely in our country and what is the use of our hard earned money to be spent in this test.
My report says: Left anterior descending artery exhibits focal soft plaques in its proximal segment proximal to the origin of D1 causing 70% luminal stenosis. Mixed plaques are seen in mid LAD causing 30% luminal stenosis. Rest of the LAD appears normal. Small D1 and D3 appear normal. D2 exhibits soft plaques in proximal segment causing 60% luminal stenosis.
Circumflex: Co-dominant vessel appears normal. Gives rise to large OM1 which exhibits soft plaques in proximal segment causing 70% luminal stenosis. PLV and PDA contribution appears normal.
Left Main Coronary Artery: Appears Normal.
Right Coronary Artery: Co-dominant vessel appears normal. Givs rise to PDA contribution which also appear normal.
The Cardiologist is insisting me to have Catheter Angiography first and then he will advice me about the treatment. I am confused sir, what to do. Why is he not suggesting me to go for stents or bypass? By the way he has given me 5 pills to take regularly. Sir, Please reply, should I go for BYPASS SURGERY by another doctor?
kamal khan.
Has the significance of disease been assessed with stress testing?
you can follow my twitter at @MustafaAhmedMD
No sir, my cardiologist told me that my ECG report is not good, so stress test is somewhat risky. Sir, please tell some thing about CT angiography, this will be useful for many other heart patients.
Slam Doctor..
Sir i have taken mental stress due to my some personal problems , my age is 31 yrs, i am feeling pain in my left shoulder and in upper back, is this refering to any heart problem??? my tention matter is not resolved yet , what should i do?
Hello Doctor,
My husband has the below issues –
LCX – Proximal LCX shows eccentric, soft plaque causing 50 to 60% stenosis.
The rest are normal . This is CT Coronary Angiography report.
Is medicine enough or he needs to go for a stent?
Thank you very much in advance.
Regards
reema
Depends on symptoms, stability and the results of stress type testing. Not necessarily any treatment needed than medicines, but needs that determined by the treating cardiologist.
you can follow our twitter at @MustafaAhmedMD
Hello doctor.
Recently i get heavy chest pain and did angiogram shows that left coronary artery was around 50%-60% blockage I am still 28 age. What should I do now shall I go angioplasty or medication. Please suggest me for long life
Thanks in advance.
Most 50-60% blockages do not need specific treatment with intervention, rather just intensive medicine and lifestyle therapy. The use of allied testing such as stress testing may help to determine the physiologic significance of the lesion.
you can follow our twitter at @MustafaAhmedMD
My heart is working at 35%. I have a pacemaker. Am I prone to have a heart attack? I had severe chest pains 2 days ago. All the test came back normal. The next day I was tired and very dizzy.
The 35% part isn’t necessarily a risk factor for the heart attack, but a prior history of artery blockage is, with those pains you need urgent medical evaluation.
you can follow our twitter at @MustafaAhmedMD
Hi. I am a 62 yr old female, with a family history of dad having first MI at 37 and dying at 40 of 2nd one. I recently had a CTCA due to this history as well as having a couple of episodes of near syncope, which may have been explained by other causes on reflection. I am overweight, eat healthy most of the time, don’t exercise enough really, and cholesterol total is 6.2 with LDL of 3.7. My CTCA showed a calcium score of 2.2 and a 10% in the LAD. All other arteries were clear. I was put on Crestor, though not really happy taking this, and tend to take every few days. Can I have your opinion please?
Hi Dr. Mustafa.
My name is Afnan from Pakistan. I’m 28yrs old.
Echo, ecg, ett, ct angiography are totally normal. Holter monitor showed 75 Pacs in 48 hours. Sinus arrhythmia and sinus brachriyda was found. Some times resting heart rate is 45. I’m a fast runner from last 2 years but now quite. I’m very worried about pacs and resting heartbeat. Please tell me what to do.
Hi sir
Angiogram report shows TYPE 2 proximal LAD has 60% to 70% thrombus containing lesion shall I go for medicines or angioplasty? Still am 26 please suggest me for long healthy life
Hi Dr Mustafa,
I am a 40 year old female had a stent put in last week due to heart attack accompanied by 1 main artery 100% blocked. After a week i experience some chest pain ranging from right to left on and off. The chest pain im experencing is different from the heart attack ive had. My concern is are there other arteries block? Should i go back and see my cardiologist before my 1 month appointment is due? Please kindly advise. Thank you very much and God blessed!
Yes you need to go and get evaluated.
you can follow our twitter at @MustafaAhmedMD
Dear Dr Hi
I am 47 years old male while doing fast bowling on Saturday I had a chest pain on following Monday at 6 am I rush to the hospital as I smoke since 25 years the first thing came In mind is hear attack after ECG and Trop I there wasn’t any heart arrack but to get this more probe dr advice me the CTAngio and subsequent to it Stress test which I ran for 11 mnts report suggests that I had calcified plaques in LAD proximity mid and distal along with circumflex less then. 40% my cholesterol without statins was 140 LDL 69 while HDL 48 weight is 73 kg with 176cm height with athletic body structure now iam on statin amlodipine and blood thinner
Could you please suggest that can I take calcium supplements 1400 mg along with VitK2 90 mcg to regulate calcification from arteries or any thing else you suggest
Thanks
I typically don’t suggest the use of supplements as there is no evidence from a medical prescription standpoint. Im not sure if they are harmful or beneficial.
you can follow our twitter at @MustafaAhmedMD
[email protected]
My wife is 88, and suffered a heart attack; as a result 2 stents were placed. Since that procedure she has suffered no chest pains whatsoever. And has accepted more surgery to insert a new heart valve. I asked her Nurse if it was possible to delay the surgery; because my wife has shown constant improvement. The only discomfort she has is from the daily 8 pill intake she was instructed by her doctor. I told the nurse to tell the Doctor of this possible delay. I reminded the Nurse she was a fiduciary, and well as the Doctor. She had a visiting nurse who called on her twice a week…for a month.
Hi sir.
I am Raju just 27 had recently diagnosed with single vessel coronary artery desease due to 3 years smoking Having proximal LAD 70% thrombus but some studies published reversible heart desease naturally After smoking cessation. Since I quit smoking is it reversible naturally? Or is there any foods to reverse naturally.
Please it’s help lot of young hearts. Thank sir.
Hi sir.
I am Raju just 27 age due to smoking 3 years I recently diagnosed with single vessel coronary artery desease having 70% proximal LAD blockage. Some study shows smoking cessation reversible heart desease naturally is it true? Currently am in medication Or suggest what foods unclog arteries naturally. Please sir it’s help many young hearts.
Thank you sir.
Hi sir.
I am Raju just 27 age due to smoking 3 years I recently diagnosed with single vessel coronary artery desease having 70% proximal LAD blockage. Some study shows smoking cessation reversible heart desease naturally is it true? Currently am in medication Or suggest what foods unclog arteries naturally. Please sir it’s help many young hearts.
Thank you sir.
Its critical to stop smoking, pay attention to risk factors such as blood pressure, cholesterol, diet, activity and exercise and general lifestyle. This can certainly act to stabilize disease and improve outcomes.
you can follow our twitter at @MustafaAhmedMD
Hi Dr. This is an amazing article. I have been diagnosed with 40% blockage on 2
Places in my arteries. I am
Only 35 years old and worried
I can have a heart attack anytime.
What is the average plaque percentage for someone my age.
I have stopped smoking and watching my
Diet. Can I reverse my blockage with a healthy vegetarian diet and exercise or maybe stable it. Is it dangeorous
To have 40%.
The 40% blockage in itself doesn’t signify you will have a heart attack, rather it demonstrated the presence of a disease process. I would certainly recommend management of diet, lifestyle and exercise as this may act to stabilize the disease.
you can follow our twitter at @MustafaAhmedMD
Thank you DR. Is this reversible. I was told it is mixed morphological atheromatous plaque.
Hi. I have athermotous and my doctor said this is reversible. Does this sound correct.
Hello Dr Ahmed ,
I appreciate your efforts.
I need your kind advice. I am 45 yrs old , lean. Around 3 yrs ago I had chest pain, immediately went to hospital. Cardiac Enzymes and other blood tests done, resulted in normal. ECG done Twice , with normal result. Echo was normal. Stress test was borderline. Angiography done. Critical disease in proximal LAD was diagnosed. PTCA with 1 stent advised. Cholesterol is normal, no diabetes, BP is within limits.
I walk and run daily for about 1.5 kms. No chest pain, no shortness of breath etc.
Now let me know plz how much is this critical blockage in %. Secondly can this blockage be hereditary??
Should I go for PTCA as I have no symptoms since last 3 years???
Looking forward to hearing from you soon.
Bashir Ahmad
From what you say the critical disease has already been treated and now you are doing well and symptoms free?
you can follow our twitter at @MustafaAhmedMD
Hi Dr, I like the article and it helps me to clear everything. My law Father has 5 blockage.
1. LMCA : 80% at distal part.
2. LAD : 90% at osteo prosemal part
3. Diagonals : 90% at D2 distal part
4. RCA : 80-90% at prosimal part
5. PDA & PLV : 70-80% at PDA
Doctor recommend us to go for CABG.
My query is how much time will we have before CABG as we have to manage a surgeon and try to get a schedule for CABG. Is searching a surgeon and managing schedule be too late. We do not understand what should we do.
It depends on stability and symptoms. If the situation is unstable for example active chest pain or heart failure, then the situation is more urgent.
you can follow our twitter at @MustafaAhmedMD
Hai,dr.ahmed
My father is 54 years old..he had angioplasty on RCA and LAD three year ago on 2015..
Recently he had EECP treatment.after that when he did a CT angiography the report showed
LAD (Stented)-highly suspicious for severe restenosis
RCA (stented)-highly suspicious for intermidiate stenosis
LCX-diffusely diseased in its entire course leading to long segment severe stenosis to complete occlusion
PDA and PLV are diffusely diseased leading to long segment severe stenosis to complete occlusion.
He also has systemic hypertension
Is bypass surgery needed
Is bypass complicated procedure.
Pls reply
Thank u for ur patience.
Assalam.
In general multivessel disease of this nature is treated with bypass surgery
feel free to follow our twitter at @MustafaAhmedMD
Hi Dr. Mustafa,
Thank you for this post and is really helpful, My dad had a major heart attack early March’18, he was treated on time with stent. The details of blockage is as follows:
LMCA: Normal
LADA: Type 3 and proximal LAD has 70% stenosis DI has osteoproximal 70% stenosis.
Ramus Intermedius: Osteam 80% stenosis
LCA: Non dominant and proximal LCX has 80% stenosis and OMI has 70% stenosis
RCA : DOminantand 100% occluded proximally and stent implamanted to clear RCA.
He is taking Brilianta and Ecosprin have done TMT after 6 montsh it is normal. Wopuld you suggest to get stents for other blocks as well.
Regards,
Yesh
Depends on many factors that include residual nature of the disease, symptoms and heart function. The treatment may be medicines alone, medicines with stent or bypass. The treadmill test is reassuring, and if normal and no symptoms it may be that medicines is the correct treatment. This needs to be determined by the treating physician.
you can follow our twitter at @MustafaAhmedMD
Hi my dad has a heart attack last week it was his 4 th heart attack . He already has stents from a few years ago and now 3 blockages again. The hospital sent him home and said they could not do anything to him as his heart is too week . He is on medication not sure what it’s called but Im not sure if that will break down the blockages . He is really scared we all are I was just wondering is there anyway of getting rid of the blockages. Or have you any advice or what we can do next there has to be some other way .
My father is a heart patient and he had 3 arteries blockages.. doctor said the arteries are so narrow that by pass is not possible, now my father is treated with medicines, his condition is right now but he is so much tensed with this disease,, what should we do next? Either we go with this medicines or any other alternate we need to do please guide. Here is his angiography report.
LAD :- Proximal = 90%lesion
Mid = 80% lesion
Distal = Normal
CIRC :- Proximal = Normal
Mid & Distal = Diffuse Disease 70%
OM1 – Proximal – Total
RCA :- Proximal 40 – 50 % lesion
Mid – 70% lesion
Distal – 80% lesion
PDA – Ostial – 90% lesion
Mid – 80% lesion
So if someone has an 80% blockage but refuses bypass surgery and a stent is to risky, what will happen?
In many cases of stable lesions, medicines may be fine. Out of interest why would a stent be too risky? What was the reason given?
Please follow our Twitter at @MustafaAhmedMD
Hello Doctor,
First of all, thank you for this great, informative website. I am 52 and just had 2 stents put into my right coronary artery on Friday. I had 95-99% occlusion. I feel great! I am a runner(was until the chest pain got too bad to continue). I am also a T2 Diabetic. I have a good history of controlling the T2 and until January, had no heart symptoms. I was just wondering if there is a way to know how long the blockage has been happening. I started having slight chest pain that I attributed to acid reflux last May, so almost a year ago. It was not bad and it stopped as I got in better shape. At the first of this year, it would not go away without stopping, and even walking became impossible by last week. Again, thank you for the information!
It depends on the appearance on the angiogram. With your diabetes and the need for 2 stents i suspect they built up over time, years. In emergencies the block is usually more acute in nature. The key for you is diabetes, blood pressure control, lifestyle and such. You can do very well for a long time.
Please follow our Twitter at @MustafaAhmedMD
Sir my father has done recently an angiography sir I want your advice in this regards what precautionary steps I have to take plzz sir
The test shows
Left main: short LM,TIGHT LESION
LAD : DIFUSE LESION 80-90%PROXIMAL PART TO MID PART
D1 : CUT OFF
D2 : SMALL VESSEL NORMAL
LCX : DISTAL LCX DIFFUSE LESION 70% DISEASE
OM1: NORMAL
OM2: NORMAL
RCA:NON CRITICAL DISEASE 30-40% DISEASE IN MID RCA
IMPRESION :CAD/DVD
PLAN : TO BE DISCUSSED
Depends on his overall situation, most likely bypass surgery will be advised.
thank you Doctor!
my wife is 73 years of age with a family history of Diabetes .
she is Type 2 diabetic. Due to family history did angiogram 21/11/2014 with the following findings : RCA Minor plaques are at the proximal LAD and proximal LCX . There are 50% soft plaques noted in the mid RCA . LCX : At the Proximal LCX there are mixed plaques present causing 25% narrowing. The rest LCX is normal. LAD : minor soft plaques noted causing 25% narrowing ,rest is normal.
LCX have mixed plaques present causing 25%-50% narrowing .
PDA : No plaque formation No Stenosis.
PLB : No Plaque formation No stenosis.
Extra – Coronary Findings
A tricuspid aortic valve is noted .The aortic root diameter is 26mm
Dr. Ahmed
Thanks for the useful information that you and other members in here provides.
My question is if there is reduced blood flow to heart muscles after a coronary bypass? I had six blocks and there was a triple bypass. My LAD had three diagonals. So, when you do a bypass with a count less than blocks, are you not ignoring some blocks – say one bypass for the LAD with 3 diagonals? Also, the older blood vessels had settled on the heart and how do you ensure that bypass graft sits on the heart all along? As a layman and ignorant, I think a combination of stent and bypass grafts would be a better way to go.
In just 3 months after bypass, I am getting pain in the left chest area – kind of unstable angina. That has got me concerned that my heart muscle is not getting enough blood!!
Firstly if you are getting unstable angina then you need urgent medical evaluation.
In terms of the bypasses performed, in general any vessel felt big enough to bypass would have been and if felt too small to bypass then stents would likely not provide further benefit.
follow our twitter at @MustafaAhmedMD
Am I left to die? I don’t want to die I want to live. I have 99% block. They said that they cant perform the bypass surgery because the obstructed vessels shrunk so small they cannot be seen even on angiogram. The Left anterior descending artery is the vessel that provides most of the nutrients for the heart and that vessel and the surrounding ones on the left side are obstructed 99 percent. Can I still be saved?
Firstly, medicines may have an important role to play here. Have you had more than one opinion? Even people with occluded LAD can do well.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Dear Dr.Mustafa Ahmad,
I have undergone for Angio test .
* mid Right Coronory artery 90% ( had stent placed)
still some more blockages noticed:
*proximal left anterior descending coronory artery has 75% stenosis (involving the origin of the D1 first Diagonal artery.
*The mid left anterior descending coronoray artery has 80% stenosis, invoolving the origin of the second diagonal artery.
As per the doctors advised to go for follow up procedure in few months , since my hand got swellen after first angio and took 2months to get swelling to go off, now is OK.
now on regular medication, Aspirin, Ticagrelor 90mg and Atorvastin 40mg.
However consultant is bit concern , swelling might come again if we go for second procedure.
I want to get your opinion, is this blockages still there can managed with medication , I was told there may not be significant improvement if we do D1 PCI stenting.
Also I would like to know Dr recoment Nucrlear Stress Test ( at rest) – Is this stress test safe a person with 80% D1 LAD and LCX blockages?
or it is advisable to stright away to do second procedure.
Nuclear Stress test can clear the blockages???? of Just Medication will improve?
I can walk , Jog fast can feel mild compression between throat and chest , is this angina?..
Also please advise Ramalan fasting is OK with this patient condition
Depends in many situations it differs, if the main lesion is treated and the symptoms are gone, then medical treatment may be ok, particularly if tests such as treadmill or other are reassuring. In terms of fasting, please make sure that you ensure critical medication timings such as blood thinner have been discussed with the treating dr.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hello doctor.. I wanted to know what kind of surgery is required for a person having 90% blockage with 250 mg/dl sugar and abnormal bp. As i am writing this on behalf of deceased person.. Just 10 days back.. The person was admitted to hsptl 3 days ago before his last breath. Doctors dis angiogram and said he has 95% blockage and will operate after his sugar and bp will b lowered was this necessary to wait for days?
Its not a simple decision, a lot depends on the stability of the patient, if the patient is stable there is a possible advantage of controlling the blood sugar first to decrease chance of operative complications and improve outcomes.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Dear doctor,
Day before yesterday my mother had undergone Ct coronary angiogram test.
Results are;
LM 0
LAD 08
LCX 0
Rca o
LCX …small vessel
RCA …dominant vessel giving off large PLC . mild disease in rca.
Conclusion
Tortuous coronories..
02 mm PDA has 60 to 70% ostial stenosis ..
Please advice what does this result mean and what should be our next step as my mother is diabetic too and recently consumed done heavy dose tho reduce sugar level
Her sugar level reduced abruptly to 152 from 260. She is facing weakness and uneasiness. Is this because of autism decrease in sugar level or because of some heart issue.
Please suggest and enlighten me.
Regards
Medical management would typically be advised in this setting.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
have 80 percent in one vessel 90 percent in the other two and cannot use stents because of 3 or more blocks in one vessel and two many small vessels that the don’t make stints for these small enough blockages. what should I do???
Medical management with optimization of medicines, treatment of risk factors, attention to lifestyle and close follow up will be key in doing well.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Thank you for this very informative post. It’s more than I have got from my doctor’s. After going to docs for numerous years and being diagnosed with joint hypermobility syndrome last year any thing I was going to docs with was put down to that however fast forward to 3 weeks ago and I was admitted to hospital with chest pain, after an angiogram I was told I had myocardial bridge in LAD with 50 % stenosis prox LAD plaque disease (says this on my discharge letter) I’m going this week for an echo, I’m wondering why they have mentioned I may need a by pass, I’m only 42 never smoked or drank excessively. Both parents have heart disease also. What questions should I be asking and what does all this mean for me? Thank you.
Thank you for this very informative post. It’s more than I have got from my doctor’s. After going to docs for numerous years and being diagnosed with joint hypermobility syndrome last year any thing I was going to docs with was put down to that however fast forward to 3 weeks ago and I was admitted to hospital with chest pain, after an angiogram I was told I had a heart attack and I’ve got a myocardial bridge in LAD with 50 % stenosis prox LAD plaque disease (says this on my discharge letter) I’m going this week for an echo, I’m wondering why they have mentioned I may need a by pass, I’m only 42 never smoked or drank excessively. Both parents have heart disease also. What questions should I be asking and what does all this mean for me? Thank you.
What is the evidence you had a heart attack?
How was the 50% stenosis determined? was it angiography alone or was IVUS or FFR performed.
What aggressive risk factor modification and medications are being done to prevent progression and reduce risk.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hi Doctor,
Had a scan yesterday using a Axial Hitachi Scenaria 64 channel 128 sclice with 3mm thickness ,high resolution .
Detected a 3.9 agatston score on the LAD.
How serious is this ? What percentage is the blockage. ?
I dont smoke, exercise everyday (eliptical bicycle) and brisk walking.
56kg BP 122/74 AIC 5.7. 58 years old.
Would highly appreciate your reply and advice.
Thanks
Was this reported as your calcium score?
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Dear Mustafa sir.
Sir due to mild heart attack in last year my EJECTION FRACTION reduces to 45% now am just 29 years old so how can I improve my low EF for long lives. is there any medicines or yoga treatment.
Is EECP treatment increases EF? Please reply sir many patients waiting Ur reply.
Advance thank you for such a wonderful platform.
Hi Doctor Mustafa,
I want to discuss my father’s heart disease. He is 66 years old and had M1 a month ago. He is not a high blood pressure patient and has never smoked in his life. He doesn’t have diabetics. He had recently high cholesterol only. The Angiography report says that he has three blocked arteries more than 70% including LAD. Below is the detail of his result.
LMS: Normal
LAD Critical tandem lesions in proximal course.
LCX: Moderate lesion in proximal course before bifurcation. Major OM has critical proximal lesion.
RCA: Dominant sub totally occluded in Mild Course.
Diagnosis TVCAD without LMS disease.
Could you please advise if Angioplasty (stents) are better for him by Bypass surgery?
I need to know this really urgently as w have to decide.
Regards,
Worried daughter
On initial glance bypass anatomy is there, would certainly consult with a surgeon regarding an opinion.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hello Doctor,
4 Days back my father had undergone Angiogram test.
Age :- 69
Have Diabetes Mellitus, Hypertension
Results are; given below
LMCA:- Normal
LAD :- Long Diffuse Disease Small Vessel
LCX:- Long Diffuse Disease
RCA :- Proximal 90% Disease
PD:- Long Diffuse Disease
Diagnosis :- Multiple Vessel Disease -> Small Vessel Disease
Doctor Advice :- Medical Therapy at present. If failed, plan for CABG.
Doctor Suggested below Medicine along with regular diabetes and hypertension medicine
Glyciphase 1 gm tab 2 times
Sorbitrate 1 tb 2 times
Gibtulio 10 1tab daily
Lizolid 600 1tab
Ranolaz 500 1 tab
Cap Deplatta A 75 1 cap
Doctor ask us to visit after 3 weeks and telling about CABG
Please suggest
What is the heart function and what was the response to medication?
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
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. I did not know that when it happened I mean when the suspected heart attack occurred. He recommended taking the nuclear stress test to further explore. What are the implications of this? and how quickly we need to act on this and what treatment can be best recommended in this situation. I need your expert advice as to what is the best solution to this and how important is to find out the root cause and go in for treatment and how long we can take time for the treatment to start.
The need to act and its speed is determined by the nature of the symptoms, stability and involvement of a specialist.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
I was just diagnosed with LAD 10-15% stenosis and Right coronory Artery – soft plaques proximal RCA wih 30% stenosis
Given plavix and concor for almost 2 weeks. Right now i am feeling dizzy even when sitting down and having my menstrual again (2 weeks cycle).. Is this normal ?
I have a stent in the rca i would like to know how thick my blood should be i do use blood thinners
Dear Dr. Mustafa,
I had an angiogram/heart cath in April, 2019 and my cardiologist said I have 80-90% blockage in the left circumflex. He said because of a “tricky turn” he did not try to insert a stent and we have been trying medication. The blockage condition seems to be gradually worsening and the meds are becoming less effective, especially at night. He has referred me to a surgeon for open-heart bypass and he is not a believer in robotic surgery. However, I live in Chicago — Northwestern Memorial (ranked #7 nationally) and University of Chicago both have excellent robotic bypass programs. Can you offer thoughts regarding open-heart vs robotic approach to guide me in making the decision? Thanks for a fantastic service of answering questions!
If in Chicago, see Dr Balkhy for an opinion regarding minimally invasive approaches. You can tell him I sent you.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Last 4 weeks my father taking the medicine. Feeling good but sometime after walking feeling shortness of breaths/
Dear Doctor Mustapha Ahmed.
I was told my main artery was clogged for 70 percent and got a Stent. The picture though shows the artery being narrowed perhaps 20 percent, not more.
I have the before and after picture and seriously wonder why I was told 70 percent blockage and got a Stent.
Please are you willing to look at my before picture, and give me your opinion?
I really hope so, thank you so much in advance.
I uploaded my picture here:
https://www.mupload.nl/img/logu0o17e.jpg
Kind regards,
Judy
hello doctor,
my husband is just 42 years old and active person. He is not at all obese.
2 months back he had mild chest pains so we rushed to the hospital. There doctor diagnosed him with mild MI and treated him accordingly. he has gone through his angiogram. Doctor said there are 50% blockages in his artery and it showed diffused coronary artery disease but no significant stenosis which would require stenting. After having his heart ultrasound doctor said there no significant damage to the heart and whatever is there will recover after having good rest which he took for 5 weeks. now he is perfectly all right taking his medicine and doing exercise.
I want to know doctor Mustafa that he has a genetic issue of high cholesterol and triglycerides and hence doctor put him on Atorvastatin 80mg tablet for life long. now his cholesterol is 3.2 which was earlier 5.8. he is consuming very less oil preferable olive oil. within 2 months his cholesterol is cut down from 5.8 to 3.2 does he still needs 80 mg dose for life long? Is atorvastatin will help to reverse the artery blockages? Increase in HDL will help to reverse the artery blockages? The nuts like almond,walnut and food items like asparagus,brocollli, avocado also contribute in reversing the blockages?
Yes sir just had a heart test done she said that one artery was blocked at 53 percent that they could do a stent if that doesn’t work that they use another method to puss it to the wall.im confused what should I do.
Dear Sir,
my dad has 100% right ride block and left side 70 and 80% blockage… bypass is suggested, but we dont want to go ahead with bypass is there any other way to treat this with surgery. he walks 2.5 km approx in morning no chestpain or breathing problem he has. please suggest
Hi Dr. My father recently had dizziness and high sweating. We showed him to general physician and his initial observations were of vertigo. But he still asked us to get the ECG done. When we showed the ECG reports he immediately asked us to visit Cardio department. There they said to go for ECHO in which they did screening and said that Angiography needs to be done. Once this was performed and reports given it mentioned:
LAD: Proximal Aneurysmally dilated with mid 100% occluded
LCX: Dominant vessel, no flow limiting lesion
RCA: Co dominant vessel, mild plaque disease
Want to know what is the meaning when they say mid 100% occluded?Does it mean full blockage or 50% blockage. Also, with this they have said to go for angioplasty followed with stent. Pls advise your thoughts and if we should take 2nd opinion on this.
100% is a total occlusion. At this point if an emergency this needs to be discussed with the treating team. If a non emergent chronic standing issue, a consultation with a heart team approach that included specialists including a surgeon and an interventional cardiologist is advised.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
My father 66yrs old had symptoms of dyspnea when walking,no chest pain. CT cardiac angiography shows
# Mixed concentric calcific atheromatous disease in mid RCA with moderate to significant luminal stenosis
#mild to moderate luminal stenosis seen in distal and proximal segments
# eccentric calcific atheromatous change in proximal LAD with mild to mid luminal stenosis.
Please advise if he would need a stent or not . He responded well to ranolazine and is on bp medication and insulin. Please
In general single vessel disease well managed on medicine does not necessarily need any intervention.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
My husband was diagnosed (via a stress test) with a 100% blockage in one artery, then a 70% blockage in his LAD. He was told later that they didn’t split that one because it still had “healthy blood flow”. How can their be healthy blood flow with such a blockage?
Good Day Dr. I have a friend who has had 2 heart attack in a 2 year time span, today they performed the catheterization blockage test(sorry if I spelled it wrong) and we came to find out he has 3 blocked arteries, two at 90% and the final at 100%. He is in his mid 40s, they are suggesting stents, would open heart surgery not be a better option? I understand his condition is serious, but how serious?
Thank you
Hi Doc,
My Father had a heart attack which led to finding out that he has to 100% Blockages in each RCA, Circumflex & LAD. His RCA was stented to relieve from the heart attack & advised to wait for at-least 2 weeks prior to consulting for alternatives for blockages in Circumflex & LAD. Today is 4th day & in your experience, what would be the next appropriate steps for Circumflex & LAD besides managing it with medication.
Hi Doc,
My father 72 with Diabetes Metillus (past 15 years) had a heart attack which led to the finding that his RCA, Circumflex & LAD were blocked 100%. Dr’s chose to perform stenting the RCA as natural bypass are developed on the left side of the heart around the circumflex & LAD. We are exploring options for the 100% blocked Circumflex & LAD and have consultation in the next 2 weeks. In your expert opinion what course of actions need to be taken besides medication for circumflex & LAD or all blockages.
RCA blocked 70-80%
RPDA blocked 100%
LM blocked 30-40%
LAD blocked 80-90%
And heart functioning is 20-25% only
Patient age is 67 years and do not want to go for surgery
Please suggest a way out
Dr. Ahmed,
I am a 55 y/o caucasian female. my BP runs around 110/74. My total cholesterol is 142, with high HDL and low LDL. My triglycerides are 90. All vitals WNL. I am 5’3, 175 lbs. Never smoked. Don’t drink. I have a diagnosis of hashimoto’s . Recently told I have moderate stenosis in the LAD. 40 to 50%. How can I have such good labs and have a narrowed artery? My calcium scoring was 0. I have not had a heart catheterization….just a CTA. Thank you for sharing knowledge with us.
Blockage development is multifactorial in nature. Genetics, environment and other factors are important. The labs being good are a good thing and probably why the disease isn’t more severe.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hi Dr. I’m a 60-year-old male. The angiogram test performed in this September reveal that I have 3 blockages: a) A tubular 60-705 mid-LDA stenosis, begins in the proximal LAD. b) serial 80% circumflex and obtuse marginal stenosis with diffuse 60-70% stenosis beyond the discrete lesion. c) Tubular 60-70% ostial PDA stenosis.
The nuclear stress test reveals a small area of severe ischemia in the basal inferior lateral segments with moderate intensity. The blood pressure dropped during the exercise and into the recovery. Left ventricular ejection fraction is about 74%.
I’m fit and healthy and exercise regularly. Weight 138 lbs and 5f 6in tall. My family has a history of CAD disease. Dad died from heart failure at 83 and mom died from stoke at 60. Brother had a stroke at 52. I have elevated cholesterol for many years but never had any symptoms of CAD, like chest pain, shortness of breath or other known symptoms.
I am increasing the level of exercise and I have been eating healthy. I’m taking aspirin 81mg, cholesterol drugs, and BP drugs. My cholesterol is very good now: total is 120, LDL is 37, HDL is 56.
My cardiologist and a heart surgeon want me to have the triple bypass surgery. They also said that it will be better than stents for the long term. I’m scared of it. I am seeking a second opinion.
Dr. Mustafa, can my CAD treated with drug and lifestyle changes? Can it be reversed? Should I go ahead with the bypass surgery?
Please give me your opinion? Thank you.
Interesting question and in many ways can be addressed by the recent findings of the ISCHEMIA trial. The question is why were the tests done in the first place? Was the situation stable? What has been the response to medical therapy?
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hello Doctor,
My father is 69 year old, complains of chest pain while walking and at times at home.
Got the CT coronary angiography test done for him and below are the findings.
Left main: Normal
LAD: Type II. Proximal LAD shows calcific plaques with segmental moderate stenosis.
Another area of focal severe stenosis is noted in the mid LAD just beyond the origin of 1st diagonal. The D1 is a prominent artery, showing no significant stenosis. The 1st septal branch is also prominent artery.
A small ramus is noted.
Circumflex : Proximally shows marked calcific plaques resulting in focal severe stenosis. The OM1 is a prominent branch, showing no significant stenosis.
RCA shows long segment plaques resulting in severe stenosis. The PDA and PLB are small caliber branches.
IMPRESSION:
Triple vessel disease with mixed calcific plaques showing severe stenosis as described.
Could you please advise if medication can help or angioplasty is required.
This depends on many factors. Acuity of symptoms, risk profile and others. Has he had an opinion from a heart surgeon and an interventional cardiologist?
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
My dad had LAD 95% had surgery in 2010 now again in 2018 he fainted and doctor recomended pacemaker so he is currently having pacemaker.
But doctor told us he is havin RCA block 75-80% which furhter need treatment.Dad is not ready for another surgery.we are worried what can we do.is he fine or anything bad can happen?he is taking prescribe medicine on time
Discuss with the Dr the indication for any further surgery. This should not just be driven by % of the block, but by symptoms, response to medicines and such.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hi Doctor ! You have really done wonderful works for increasing awareness about the heart blockages. Can I know you email ID ?
Sir my dad has
LCX is anatomically co dominant vessel-normal, OM-1 proximal short segment 90%stenosis, OM-2 ostio proximal short segment 90%stenosis, OM-3 mid two tandem 90%lesion, LPDA-ostio proximal has 50%stenosis
RCA is anatomically co dominant vessel, proximal discrete. 90% stenosis, distal RCA short segment 70%.
Already a angio has been done LAD Type 3 vessel mid lad 100% occuled earthly diagonal/ramus small vessel,diffuse disease…
Sir pls tell for this what can we do sir angio is best or bypass sir….
In general with complex multi-vessel anatomy like this, and if appropriate based on patient characteristics bypass surgery would be strongly considered in this setting, if indicated.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Sir my father age is 47 and he has type 2 diabetes mellitus
Sir
LMCA- Normal
LAD- type-3 vessel, proximal LAD plaquing, mid LAD 70% stenosis with haziness, distal LAD plaguing.
Diagonals- D1 divides into two branches; upper branch plaquing, lower branch subtotal occlusion with distal TIMI I flow.
LCX- Non dominant, small caliber vessel, Latium 50% stenosis followed by plaquing, distal LCX total occlusion, filling faintly through heterocoronary collaterals.
Marginals- Major OM plaquing.
RCA- Dominant, mid RCA plaquing.
PDA/PLV- PDA distal 60-70% stenosis. PLV proximal 95% stenosis, distal TIMI II flow.
Doctor please suggest what is the best option for the above report.
In general, if indicated, the anatomy as described above should be evaluated by a surgeon for consideration of coronary bypass surgery. A discussion between the cardiologist and the surgeon discussing the merits of any given approach should occur.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hello Doctor
My father was supposed to go for both knee replacement this weekend and in the preliminary tests doctors suspected some issue in heart. After Angiography, it turns out he has 85% blockage in RCA, 80% in OM and 50% in LAD. Are these blockages safe to proceed with the knee replacement? Also, how long does it take for an 85% block to convert to 100% ? Is it a serious issue and needs angioplasty right away? My father can hardly walk now and is desperate for a knee replacement.
He needs to be evaluated by a cardiologist who can determine the risk and suitability.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
I would like to show thanks to you just for bailing me out of this this particular trouble. As a result of checking through the net and meeting techniques that was not productive, I released my life was done.
hello sir the doctor that my dad has block im his heart
but we are unable to find out what percentage of block he has
can u please help us out to find the percentage of block
it would mean the world to us
I am 59 years old, active, not overweight male. Family history of CAD. I am experiencing fatigue. had a angiogram showed 85% blockage of OM1, Doctor decided to not stent and treat with medicine. would this be something that is typical for my situation? On a beta blocker, baby asprin and 40mg lipitor.
When evaluated by a specialist, medical treatment of lesions is often appropriate and the correct initial step prior to stents.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hello,
My father age 71, had radio frequency ablation in 2016 for atrial flutter. At that time angiography was done.
Lmca was normal
Lad type III,mid lad 50% lesion rest ok
Lcx dominant,lpda at ostium 30% lesion
Rca non dominant mid rca 90% dominant.
After the rfa had many episodes of irregular heart beat but those resolved in a few hours. Last week had an episode with severe stomach cramp along with pressure in the chest area and sweating. Again same thing happened yesterday with severe stomach cramps leading to passing stool and chest pressure in the heart region. At the time he is not able to get up from the commode. Although after some time his condition is improving and getting back to normal
What may be the issue and possible treatment?
my husband is 39yrs old and have the below blockage. Does he need stent or changing in lifestyle would help? three vessel CAD with severe high grade proximal stenosis in the ostium of the LAD and a subtotally occluded circumflex system. they said 70% blockage
In this case, surgery will likely be recommended.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
My Cousin just had a heart attack the Dr put 2 stints in her heart stating she had 2 blockage then the next day she was rushed back in for surgery because they found another blockage My question is why when they went and saw 2 blockage they didnt see the 3rd blockage?
Im not sure, there may have been a complication of the initial procedure or other explanation. Its different in every case and the films would need to be reviewed to know.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hello Doctor I wonder if you can help my wife has an artery 90 percent blocked can a stent still be inserted
It depends on many factors and the films would need to be reviewed. These include vessel size, area supplied, area at risk, symptoms despite medicines and other factors such as procedural risk.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
First i would like to thank for this information this really helped me to understand my fathers angiogram report i wanted to ask at what percentage of blokage a stent need to place and can a blokage be traeted by medicines my father has been taken medicines for 3 months ; ramcor, embeta rx, pentropxole.aspirin and statins are these safe
Typically stents are for 70% or more blockages with symptoms.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hello Dr at the outset many thanks for your valuable inputs via thus blog which has Ben beneficial to so many. Dr a month back I suffered a MI. From the onset of symptoms within 4 hours I was in the hospital and was immediately given injection to burst open the clogged arteries. The next day an angiography was done which showed a 80% blockage in the LAD. Since it was just this one blockage, Angioplasty was done and a single stent was placed. I was discharged after a week. The echo post my MI shows my EF as 35%. I am a male , age is 48 and I have no other complications such as diabetes, no BP, no obesity or any such complications. I was a smoker which I quit post my MI. I have been active all through my life exercising 3 to 5 days a week. ( tennis / cycling). My question is my EF is mentally bothering me . Is 35% too low ? Will it improve over time ?and can it lead to sudden cardiac even if I’m exercising, and maintaining a healthy lifestyle ??
I am an active 60 year old male who enjoys cycling and distance swimming. I need an AVR and have a Single lesion LAD I am getting different opinions as to how to treat this. Some surgeons are recommending stenting and some recommend LIMA to LAD bypass. Those who recommend stenting are saying I can get my valve replaced minimally invasive(not TAVR). Knowing I will will need another SAVR in 10-13 years, is it reasonable or acceptable to go with a stent and MIAVR now saving my sternum and LIMA for my next OHS? Thinking this will help with a quicker recovery on my second OHS as I would be older. Is one inferior the other?
After my Cath my Dr said my RCA was 90% but since I have left dominance that no action is required for RCA. He did stent my LPL and LPDA. LAD had mild plaque but it’s diagonal had 75% but said still this is ok to leave as is. The LAD is fine. Should he have stented these others? And was the LPL and LPDA important enough to stent?
Dear Doctor,
Thanks for the information first.
My father has
LMCA – 80% Stenosis in Ostial segment
LAD – Mid LAD is calcified and 70% Stenosis. Distal LAD is graftable.
LCX – Proximal has long 70% Stenosis. Mid and Distal LCX have plaquings.
RCA – MID RCA – 70% Stenosis. Distal RCA gas 80% Stenosos. PDA and PLV has 80% Stenosis at its origin.
With above observations, bypass is the only option? Kindly advice.
Typically in this setting bypass would be advised for that anatomy if the patient is felt to be a good surgical candidate one assessed by a competent cardiac surgeon, if not a good surgical candidate then a heart team approach which would include an Interventional specialist would be useful.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.