Pretty much everyone knows someone who has had a stent placed in his or her heart. The story told by the patient with the stents is classic. The chest pains had been coming and going for a while, but they had been passed off as indigestion or muscle pain. Tests were done, and showed that in fact these symptoms were due to a blockage in one of the main arteries supplying the heart! They were lucky to have made it this far, but luckily the cardiologist was on hand to save their life in the nick of time by performing an emergency stent procedure to open up the blocked artery, without which they would probably not be alive today! But is this true or is it a large misconception about the true effectiveness of stents?
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It’s not hard to see why people would naturally think that the stent saved their life, in fact just put yourself in that position. You begin to have some symptoms of chest pressure when doing things, and notice that you are getting tired more easily. Your parents both died from heart disease, and you of course are very worried that your heart may be the cause of your symptoms. You go to see your doctor who orders a stress test. The results show that the test is positive and you probably have a blockage in one of your heart arteries. You find yourself lying on a table having an angiogram, a procedure done well over a million times a year in the US that involves injecting a small amount of dye in to your heart arteries to see directly if there are any blockages. While you are still lying on the table, the cardiologist tells you that they have found a 70% blockage in one of the main arteries that supplies your heart, and this is the cause of the symptoms. Of course, this is a scary prospect, and you feel vulnerable given that a problem has been found with your heart.
There are two main options at this point. The first option is called ‘optimal medical therapy’, remember this term, its important (see table 1). This involves taking a number of medicines that are proven to improve survival and symptoms in people with coronary artery disease (read ‘Should I Take An Aspirin Every Day?’), paying close attention to lifestyle factors such as weight and diet, and ‘modifying risk factors’ such as stopping smoking and ensuring co-existing conditions such as diabetes are managed in the best way possible. The other option is that in addition to this ‘optimal medical therapy’ a small tube called a stent can be inserted into the artery through a tiny hole in your groin. This stent is placed in the area of the blockage, opening it back up again, and making the 70% blockage a 0% blockage to allow the blood to flow normally through the artery again. Of course stents appear to be an attractive option. After all, it’s a scary prospect to be sent back home with a 70% blockage still there and just medicines to treat it. It is not just a scary prospect for the patient, but also the cardiologist, as naturally an artery always appears to be more pleasing to the eye and the brain, with a 0% blockage rather than a 70% blockage! But this is where it gets interesting.
The goal of treatment of coronary artery disease is to make the patient live longer, be safer, and feel better. Although the stent provides immediate visual satisfaction by getting rid of the blockage, does it achieve these goals? What if even though there is a 70% blockage, putting in a stent did not make people live any longer, did not reduce the chance of having another heart attack and did not reduce symptoms in the long term? And on top of all that, putting a stent in can expose the patient to additional risks, including that of the procedure itself and the chance that the stent could later block off, which would cause a heart attack. This is why it’s not as simple as just saying let’s put in a stent, as before this can be recommended we need proof it’s in the best interests of the patient. Physicians pride themselves on following something called ‘evidence based medicine’. This is the cornerstone of modern day clinical medicine and basically means that whenever possible, the recommendations made to patients are not just made up based on what we think, but rather formed as the result of well-designed clinical trials that have shown that those treatments have a proven benefit.
So when do stents save lives? We know for a fact, based on the findings of numerous studies that in emergency situations, for example, when someone is having or has recently had a heart attack, unstable symptoms, or a major blockage in a critical area, the use of a stent or even open-heart surgery to open up a blocked artery is clearly the treatment of choice. In these situations the stent may truly be lifesaving and improve quality of life by preserving the ability of the heart to beat normally.
But what about non ‘emergency’ situations, which are by far the more common situations, or what we call stable coronary heart disease. An example might be
the patient who has symptoms such as chest pain when they push themselves that disappear with rest, and is found to have a blockage in one or more of their arteries that is causing those symptoms. For years we thought it was obvious, naturally one would think that placing a stent getting rid of the blockage, will both make the patient live longer, feel better and lower their risk of more problems. It was very surprising therefore when several well-designed, large, international trials demonstrated that when compared to the use of ‘optimal medical therapy’ the use of stents had no added benefit when it came to preventing death, heart attacks, the need to use further stents and most surprisingly it was often no better in relieving the angina symptoms.
These findings were reported widely in medical journals, and the media, and went against everything that everyone had thought up to that point. It turned out that in the case of stable heart disease, where although the blockage is the cause of the symptoms, it is not in an area considered immediately life threatening, it would appear that an initial strategy of using the correct medicines, careful management of co-existing conditions such as diabetes, and close attention to lifestyle changes such as diet, exercise and strict avoidance of smoking is preferable to placing a stent. Not only does this have the same impact as placing a stent on saving lives and improving quality of life, but it avoids the risks associated with placement of that stent. The beauty of this approach of course, is that in the case where it fails to work and the symptoms persist, a stent can always be placed at a later time if required. And the studies proved that doing this does not place the patient at any increased risk.
But how can it be that simply using medicines, lifestyle changes and treating other contributing conditions such as diabetes can be preferable to getting rid of the blockage with a stent in people with stable disease? There are a number of reasons for this. Coronary artery disease is a disease that affects pretty much all the arteries in the heart. It weakens the walls of the heart vessels and leaves
them prone to rupture and a heart attack. It turns out that even if you have a tight blockage in your arteries causing the symptoms, it’s often another area that bursts and causes a heart attack, an area that may have appeared normal previously! This is why it’s critical to treat the whole disease process and why simply putting a stent in a blockage may not reduce the risk of further problems. In addition to treating the disease process and preventing the disease from progressing, lifestyle changes and medications allow the heart to become more efficient and improve blood flow in the arteries. This may effectively treat the symptoms and prevent the need to place a stent, and therefore prevent the risks associated with stents.
Hundreds of thousands of stents are implanted each year to treat stable heart disease, and despite the fact that there is a wealth of evidence to support the use of medicines initially for the treatment of stable coronary disease, less than half of patients presenting with stable disease have a trial of appropriate medical therapy first, probably because practitioners continue to hope that the stents will be better. The problem is that when it comes to the decision to use stents first in this setting, there is no proven benefit, but there are definite harms.
The studies that looked at the use of stents in stable coronary disease are not perfect, however, and many questions remain, particularly for those stable patients considered to be at higher risk. In these higher risk patients the best course of action is not known at this time and it is this group that is the cause for most of the ongoing debate. In that group, although the blockage is not in an area considered to be immediately life threatening, the area supplied by the blocked artery is relatively large, often causing results for tests assessing this such as a stress test to be read as being in the range of moderate to severely positive. Some would argue, based upon the findings discussed above, that in this group medicine and lifestyle change should still be tried first. Others would argue that since the blockage is in an area of an artery supplying such a large territory of heart muscle that a stent should be placed straight away. Unfortunately there is no convincing evidence to guide us either way and therefore neither strategy can be labeled as being right or wrong. The good news is that ongoing trials and study should help to answer this question within the next few years.
Over a million stents are implanted in the US each year to treat heart disease, and many of these are truly done as lifesaving procedures. Many, however, are done in the setting of stable, non-critical coronary disease without an initial trial of ‘medical therapy’ despite the fact they there is a wealth of evidence to support the use of medicines and lifestyle changes as the initial treatment of choice. The truth is however, in the setting of stable, non-critical, non-high risk disease, stents do not save lives, do not reduce risk of bad events, and are often no better than medical therapy at helping symptoms.
If you liked this article and would like to read more on heart attacks and how they should be treated then have a look at our expert articles ‘Should I Take An Aspirin Every Day?’ and ‘The Widowmaker’. Also read our article What is the Best Stent for Our Patients?
it would have been nice had my doctor told me at least some of the information in your article.it’s been 3 years since my heart attack and only by reading this article have i realizes how bad my heart attack was.thank you for taking the time to post this. unfortunately i just learned that i will have another heart attack,it’s just a matter of time. i have changed my life style i hope it’s not to late.
My name Mohd Javed sir pls help me my mother rca 100℅ block lad 80% n lcx 80% block wat I do sir I’m very poor doctor told me go for by pass…..
While y our article was a wealth of information my question was not answered. My son 70 y.o
has no symptoms of heart problems. His history is that since about age 20 he has been an alcoholic & multiple street drug user. One major problem is his denial that he is not healthy. He has never had a heart attack. His father died from heart failura at age 42. Family history is on my family and his family alcholism, ; heart attachs and strokes. So, I believe much of his problems could be genetic. When married we did not druink or use drugs. I fathfull looked after my health & my husband wouldn’t do the same. His first heart attache was at 34 y.o.Neither my sone or ex husband listened to the M.D.’s My son still drinks to excess, may use marijuania, smokes 2 paks a day. w/medications if he doesn’t see any change in 7-10 days he says they are bullshit and stops taking them w/o consulting his cardiologist. I am 80 yo w/ severe osteoarthritis. My question: w/no previous heart problems, the hospital found he heeded and received 3 stents & they were put in so does the means he has heart failure?
My name Mohd Javed sir pls help me my mother rca 99℅ block lad 80% n lcx 80% block wat I do sir I’m very poor doctor told me go for by pass…..
Hi, I had answered you post in the heart blockages post replies, please have a look there and let us know if further questions
Do you have a direct email address?
Your article is very informative and dispelled a lot of doubts of why stents were not used for my 40% block of LAD and 70% block of LCX when I had a heart sttack due to. 99% block of RCA on 1st Feb. A stent was used to remove only the block in the RCA without bothering to remove the other two blocks. I dud not understand why till I read your article.
Now the cardiologist has given me medicines to tackle the two remaining blocks. I thought the medicines will eventually eliminate the blocks. But from your article I understand the blocks will not diminish in size and that is very scary for thst can progress to bigger blocks if my diabetes cannot be controlled at a later date. Did I misunderstand your article?
The information i just read was very helpful,because i was told quite a bit of information about the stents that was placed in my heart in2014 June 16 it was more than what was explained to me at the time. But at the same time it was pretty much the same but i needed to read a little extra thank you very much for the information. GOD BLESS GOOD People like you keep on helping people like me.
Sir Coronary Angiogram was done for me on 15-10-2011 —- RCA: Right dominant circulation. PLVB shows discrete 90% srenosis… Treatment : Adhoc PTCA + Stent to PLVB(3.0 x 13 mm ZETA) was done through right radial approach. On continuous medication.
CAG was again dine on 23-12-2013 due to chest pain. Conclusion: Mild CAD. On medical management since then.
CAG was again dine on 06-02-2016 due to chest pain…. LAD proximal 80% eccentric lesion near D1… Advised: PTCA + STENT DES to LAD..
Please provede your guidance sir — Hemanth Kumar, Hyderabad
My husband had a 100 percent blockage of LAD and Circumflex. They did 3 stents and plan to do 2 more in 2 weeks they said he was not a candidate for open heart. He also had a stroke 2 years ago and had a stent placed in his carotid artery. He is not overweight and does not have diabetes but a strong family history of heart disease. I think his prognosis seems grim. We have 2 sons who are early 30’s I think they should be aggressive in their checkups for heart issues. What do you think. Has the left side of my husbands heart ceased to function and without a proper blood supply what will happen?
I know of someone who’s had some of the angina symptoms (chest pain, shoulder and back pain). After receiving medicines to help pain she was feeling well, further testing showed signs of potential complications. An angiogram was called for and the doctor stated there was an artery that was 100% blocked, which seems very unlikely but a stent was placed to fix the blockage. My question is will a 100% blocked artery only show mild signs as i described above and relieve the pain after medicine? No shortness of breath, ability to lift was there. I feel as if the doctors did the procedure out of spite for $$. I know this is a very serious matter and a lot of people are being saved daily with this, I’m just not sure how to begin or who to ask for guidance with this. Also, the CATH lab will not provide pictures of the blocked artery.
Hi Dr.Mustafa, I am Ray from China, my father had a stoke in 2007 and after that he was found diabetes, his left side can’t move. In 2016.4.25, he feels chest pain in mid-night, and last for 1 week, we took him to hospital and CAG shows the left main artery has block 60%, and many other blockage 70%~80%. Doctor suggest 3 stent treatment. I am not sure which is the best way to treat this condition. Shall we put stent or other treatment? For my father, a bypass surgery would be a big surgery for him, and his left side can’t move, I worried it’s would be too big harm for him to do a surgery. Does his condition very dangerous? I don’t 100% believe Chinese doctor, they may exagerate the dangerous and encourage the stent surgery to rise incomes of hospital. Could you please help to answer my questions?
Hi Ray, if there are multiple blockages in different arteries that are felt to be complex, then surgery is often the best option, however in this case if there is concern for rehab then stents could be considered. Without seeing the angiogram itself its difficult to comment on the suitability of stenting. However if suitable then stents in the most severe blockages may be the best option.
Can you please tell me the name and manufacturer of the exact cardiac stent shown in the image at the top of the page?
I just went to a hospital ER doctor put 5 stent in lad looks like save my live and gave me a lots of pills due to high cholesterol high blood pressure I like your article very much ,explain to me a lot doubts
Thanks for the information, I am waiting to have a catheter to see the direction they
take as I have a blockage. I am on medication now and found your article helpful.
Help! How can only one artery be totally blocked and no other heart arteries show any evidence of disease? Symptoms of 3-5 years culminated in a recognized heart attack and stent placement, and I have been told permanent heart damage was averted by heart cath and stent placement within 1 hour of ER admittance. Then, why don’t I feel better?
I was hospitalized a year earlier with SOB and chest pain, discharged with referred to a pulmonologist; there was no mention or referral to a cardiologist, despite heart tests done, some of them more than once. There seems to have been some malpractice; an artery does not become totally block in a year.
SOB has never totally resolved. My SOB did improve after the stent, but never fully resolved and several months after the stent, there is still some SOB, despite continuing Symbicort and Montelukast on the recommendation of the pulmonologist from the previous year.
The cardiology group is not very helpful, and during a routine scheduled visit, per their protocol, a stethoscope never touched my body. Mild, radiating chest pain began about a week after the stent and continued for a month, when it was severe enough to send me to ER where the EKG was declared as within normal limits. The chest pain continued and was finally diagnosed as costochondritis a couple of weeks later; it took a couple of more weeks for my primary care physician and the cardiologist to agree on treatment; by the time treatment was agreed upon, the chest pain was improving.
I am a retired medical professional, and don’t understand how CAD can affect only one vessel, and why the stent that was shown to be functional, has not improved my everyday function.
My HX: BP on the low, normal side, lipids very good, HDL very high, LDL very low, Cholesterol 150 or below, prior senior lifestyle, active with walking at least 1 mile per day; I would like to feel well enough to do that again. A non smoker who has never used street drugs, and is nutrition aware, family history of longevity (over 100 years), heart disease, and cancer.
My meds now, are only Plavix and 81 mg. aspiring, and the pulmonary drugs, Lipitor was discontinued due to debilitating musculoskeletal pain and the two BP meds were discontinued when my BP was dangerously low ( these two were probably never needed). All of this seemed to be part of a standardized treatment, without any consideration of the individual patient.
I am not interested in litigation, even though it seems that there may have been negligence several times. I only want answers to improve my life or find ways to adjust to a problem that will never get better. Surely there are explanations that I have not be advised. All this doesn’t fit together, and there has to be a better answer than, per my cardiologist: “we don’t know as much about heart disease as we would like”.
Any help or answers will be greatly appreciated.
My cardiologist put a medicated stent in my 95% blocked coronary artery 7 months ago. My symptoms before the procedure were a great feeling of not getting enough oxygen! I did not have chest pains or a feeling of heartburn as one might expect. I am a 68 yo male in fairly good shape. My total cholesterol is now down to 137 from being around 260 before taking 80mg Lipitor each night. I am doing good now.
I had a stress test and it came back that I may have a blockage, but due to my weight (I am a 60 YO female, 350 lbs) he said he cannot be sure as it may be giving a false due to my weight they cannot see.
I went to him because I want to start an exercise routine and sometimes after exertion I am short of breath, I believe, due to being very obese and out of shape (?) Otherwise I feel fine- even better lately due to some weight loss and increased activity .
he wants to give my that categorization with dye , which I read could damage kidneys– & depending how that goes they may want to immediately put the stent in — I DO NOT WANT This procedure– what I want is to continue to lose weight, gradually & steadily increase
exercise and have a stress test again in say 3-6 mos? I am on Lipitor, I have managed diabetes & managed HBP. I eat good healthy food, out of my own garden & do not eat alot of meat….
Please offer me some thought, Thank you
The only absolute indication for heart catheterization would be a high risk stress test, it is reasonable to treat low and intermediate risk stress tests with medicines alone, particularly if your treadmill test is within normal limits.
Dr Ahmed,
Thank you for your quick response. I had the nuclear stress test, not the treadmill. The Dr said he could not be sure of what he is seeing due to my weight…so he says the only way to be sure is this catheterization…then if that is positive they would want to right then & then do a stent.
With this , what are your thoughts….just medicines…blood thinners?
Again, Thank you very much..
Lindy
I think it would be a little irresponsible to answer without having seen you in a clinic setting and not having seen the stress test. I always prefer the treadmill test whenever possible as it can clear up some of the questions with indeterminate tests. If he feels its possibly a high risk test then in that case catheterization is preferred. If he feels its intermediate risk or moderate then its a decision based on factors such as clinical risk. I suggest you discuss with him the rational behind each approach in your setting.
Hi my name is Rebecca and my father had 3 stents put in about 4 years ago the first 2 went well and he came out and continued his fmdaiky routines but as for the last one he said the doctor hurt him really bad while placing it in the doctor told my mom that he did hurt him because the stent would not go in because the body was basically rejecting it so I’m assuming he forced it in any way,so about a week after my parent were walking to church which is about 3 block away from there home my dad had to stop with in a block away from home he told my mom his legs felt very tired which was not an issue ever before and he couldn’t make it the rest of the way so they called the doctor and they got him in and said everything was fine then slowly other things starting happening he started to trip , then it progressed to falling , then he slowing lost his speech they went back to the doctor and they tested him for a stroke and it came back negitive and that’s when they diagnosed him with als my dad was torn apart he feels that somthing went wrong on the operating table because it wasn’t till his last stent that these symptoms accrued . My question could that be possible and is there any way to find out if forcing the stent in cause it ?
Firstly, sorry for what he and you are going through.
I have not hear of ALS being precipitated by difficult stent placement. Im also not familiar with the body rejecting? stents, do you have more details.
I have also done in February month spent in tmh jsr I m 36 years sir can tell me can I do the hard work for few month
I found this article to be fascinating. I am 71 years old and had a stent about 9 years ago.
The heart specialist literally said when discharging me with a sheaf of prescriptions, “No questions!”
Nurses and I had worked hard for days trying to eliminate chest discomfort before release. We were unsuccessful.
I pestered the family do and heart specialist until they sent me to a bigger city for a ‘dye test’ which resulted in immediate stenting.
Since then I have had constant discomfort behind the left ‘man-boob’ – not debilitating but a pain nevertheless. I have been given numerous stress tests, ultra sound and tomography (?), the gold standard. The docs have thrown up their arms in exasperation and surrender.
The point of my message is that I can relate to the point made in the article above that maybe the stent is not always the magic cure. I feel worse after the stent, though I continue to ingest an armload of medicines daily.
Dr. Mustafa Ahmed is a tremendous teacher, in simple language educating us who have heart problems.
Thank you Dr. Mustafa!
Hello sir ,
My Question is-100% blockage means what?
1.Is it due to 100% Atheroma only
OR
2.Atheroma with Blood clot
Most likely is progression of plaque with of course elements of thrombus that hardens over time.
Ok sir , it means Thrombus is required to completely block the Artery , Ri8??
Usually an element of thrombus is associated, yes.
Hi my blood tests showed I had a heart attack, my my treadmill test showed my heart working at 92% could have done better with right shoes on and letting go of the bar, my scan shows I haven’t damaged my heart, I’ve to go for the dye in my blood as I still get bouts of angina well that’s what I think it is , I do not want a stent wich I will say to the doctor is it possible to have a heart attack without damaging it I’m on all the relevant medicine I don’t smoke or drink and have been always relatively fit i use the treadmill and eat quite well no ready made meals all home made still don’t believe I have had the attack
I can’t say whether others should get a stint, I’m a 47 year old female, no indicators others than being a smoker, all other blood work and bp were great, but I suffered a massive heart attack with stemi a few days ago and a stint saved my life. I was 100 blocked left upper ventricle, but no symptoms. I have 60% blockage on the right and am hoping life style changes will keep me from needing another. Like I said it’s only been a few days and I have no idea what to hope for. I have only 30% flow right now and am hoping it gets stronger?
Oh and I just realized it was the widow maker. The main left artery that was 100 blocked. !!!
Dr Mustafa,
I had my second stent last week placed in the LAD which was 99% blocked as it was for the first stent two years ago. I have another artery which is 40% blocked. My question is whether their is any significance in the blockage forming in the same artery in proximity to the previous one?
Why is the plaque not forming in another artery if the cause for buildup is bad dietary habits?
The 40% artery was the same as 2 years ago. No change. Is genetic factors responsible as I have a sibling who maintains healthy lifestyle but had the same LAD issue but doing ok with only one stent in place?
What an informative, easier read on a very scary and complex subject! Thank you very much doctor for writing this article for anyone who has concerns and questions regarding stents. My mother had two heart attacks in 2016 and she now has three stents. I know that if it were not for the stents my mother would not be here with me today and I would feel complete devastation! Doctors are a gift to this earth… thank you for ALL you do every single day to save our lives and to comfort those who are sick!
My mom just got stent put in will she have have to have to live near a hospital for the rest of her life,she currently lives an hours drive from any hospital or doctors office.we were thinking she should move closer to a hospital.
Hello. You mention in your 2013 article “The good news is that ongoing trials and study should help to answer this question within the next few years.” Are these trials completed and can you summarize your opinion of them. Did they help answer the question as you mentioned.
Thanks,
Michael
The question has not been definitively answered, the closest we will come in terms of trials is the ongoing ischemia trial. https://www.ischemiatrial.org
Hi,
My husband was having chest pain and loss of breath in 2003, We went to a hospital where he had a stress test an angiogram, was diagnosed with blockages and then was transferred to another facility where they placed 3 stents, then in 2004 they did a CABG, today they are saying blood flow is not getting to the bottom half of his heart and that they can’t place anymore stents. they are saying there are no other option but transplant, which he is not a candidate for? Whjat happens now!!!!
There are many options in the setting of ischemic cardiomyopathy, its complex however and difficult to comment without seeing the films or all information. Have you sought 2nd opinion or discussed the details of the case with your primary cardiologist?
my father, 97, will have a stint put in by kaiser ( posibaly), by angiogram, is this risky for him being 97, how common to have done at 97/success rate?…
A lot depends on his overall health and the anatomy of the disease, in my opinion age is never an absolute contraindication but it does make a careful thought out and considered approach necessary.
I am 38 and just got a stent placed in my heart due to 95% blockage and chest pains. Is it normal to have some discomfort in my chest after the procedure? It was done 3/6/17.
Hard to answer without knowing ll the case facts, i suggest bringing this up with your cardiologist.
Hello Dr. AHMED. Myou daughter has been diagnosed with stage 5 kidney failure. Both of her kidneys. My question is we did a match for a kidney transplant. We matched of course. I am a 58 years old female who had a major heart attack with 2 stents put in On June 21 2016. I was given a stress test called SESTAMIBI and the cardiologist says my heart would be strong enough to stand the kidney transplant procedure. What is your advice on this situation? Thank you for your respond! A worried mom.
The stress test demonstrates that there is no evidence of significant artery blockage and that the blood supply is adequate. Its important to obtain an echocardiogram and know the heart function. Its also important to discuss with your cardiologist if its ok for you to come off plavix for the procedure if the surgeons need that to happen. Your stent is within the year so they may ask you wait a full year.
Had a STEMI heart attack on 3/19/17 and a stent was installed in my right coronary artery (100% blocked). I am scheduled for another stent in the LAD “widow maker” (75-80% blocked) on 4/20. Also getting some sort of pressure test on a third artery, with possibility of a third stent. This article kind of depressed me, but am optimistic that I might be better off after the additional stent(s). Also starting a medicinal battle (10mg Effient, 81mg Aspirin, and 80mg Lipitor daily). This, along with a Type 2 Diabetes diagnosis last December has suddenly made me feel very old and on borrowed time – I’m 64 and hope to see a few more years.
On dec 8th 2015 I suffered a heart attack, in hamilton ontario canada. The hamilton general hospital has a heart investigation unit that diagnosed a significant heart attack. While stinting the blocked artery, they poked around and found I also have two more blockages, one at 70%, and they other is a 90% blockage.
I was enrolled into a study called “Complete”. 120 countries are studying this exact topic, wether its better to stint, or medicte. Computer gave me the the “treat with meds side of the study, and im not to happy with that one….lol
Only difference between how I felt before, the heart attack, and after is, I can take the summer heat better. The exercise s the ill sucks
Dr. Mustafa Ahmed,
Just want to take a moment to tell you, thank you for doing these videos and explaining this topic, as we just went through all of this last month with a sudden 100% RCA blockage. The lucky thing about this heart attack was, he just got home from work and sat down to watch a movie when it hit him.
Within 30 minutes, he was on his way to the Cardiac center and immediately rushed to have a stent put in, which got him going again. The specialist said, since getting him to the hospital so quickly, it all appears to be no heart damage.
I have been watching your video and reading your information here, to be informed and I must say that all of this is exceptionally well explained and presented. I thank you for this, as my husband’s caregiver and wife of 34 years, it is something that I need to know in depth to watch for the signs of any future trouble.
Thank you so much for taking the time to do all of this and post it on the internet. It has helped me more than you can know.
Im so glad you found it helpful, that was the aim! Also its great to hear it was managed well and there is no heart damage. Its important at this point to realize that attention to detail such as control of risk factors, follow up, medications and lifestyle are all as critical as the procedures performed.
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
Ppleasehelp me to understand these results of an angiogram done yesterday.
The results as per the letter from the consultant are.
Left main stem: normal
Left anterior descending coronary artery (LAD): mild proximal lesion
Left circumflex coronary artery(LCx): minor proximal lesion
Right coronary artery(RCA: mild diffuse disease
It says only mild CAD
Plan
Prescribe Aspirin in view of documented mild CAD
Arrange on going follow up of dilated aorta
The news is generally good. The artery disease you have is mild and there are no significant blockages. You should still pay attention to risk factors such as smoking, diabetes, blood pressure, lifestyle, exercise etc. It mentions a dilated aorta and i suspect follow up of that to ensure stability was advised although its difficult to comment without knowing specifics. Read the following to understand your blockage better. https://myheart.net/articles/heart-blockage-explained-with-pictures/
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
I just had an episode 2 weeks ago at my job and I was ended at the Hospital, with all the test I have the ECG shows I have Sinus BradyCardia and probable Left Ventricular Hypertrophy. Then just 2 days ago, I had this Cardiac Catheterization and the doctor said that the vein behind my heart has 100% blockage but with the help of other 2 veins they help pumping blood on the blockage one. Now I have a question? If I have 1 blockage vein in my heart why they didn’t put the Stent? Will it be cute by Medications only? I walked 35000 to 40000 steps in my job for 10 hrs and burned 3500 to 4000 calories too. My blood pressure is usually 140/60 or lower than that and I lost 65 lbs in my job for 8 months now, I used to weigh 200lbs before.
Thank you for this article. My doctor chose not to place a stent, and I didn’t really understand why—now I do, it was the right decision.
Hi I m 34 year old male I had 1artery 90% blockage and other 50%and 65% I had two stent before 15 days I m having diabetes from 3 yrs and my parents also have history of heart attack. I want know how much life is remaining for me. If I have regular medicine or doctors check ups, and have change in my lifestyle. Please do reply..
The key is lifestyle change, diabetes control, medical treatment and regular follow up. If you are followed carefully and pay attention to cardiac risk factors, particularly the diabetes then you may do well for a long time. You have an aggressive form of disease and need to be aggressive in the way you treat your risk factors (diabetes, blood pressure, cholesterol etc)
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hello Dr Mustafa, my father went thru bypass surgery 10yrs ago and he is diabetic. recently he is complaining about tiredness if uses staircases and little walk. Angiogram procedure showed out of 3 , 2 are 100% block and 1 is 95%. he is 77yr old and doc says not fit or eligible for stent procedure. what would be the best path for us for longetivity ? we are worried. any advice will be very much appreciated.
thanks mahant
Its difficult to answer without seeing the angiogram and knowing more of the story. Options would include repeat bypass vs. cto stent procedure vs, medical management with each case being very different. What options were presented to you? Did you seek a second opinion?
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Hello -To keep it brief! I am 57yrs and normal weight 57 kg, healthy diet, exercise reg.
I have recently had a stress test -negative. Coronary CT Angiography:
1. Total calcium score 0
2. Approx 50-60% proximal LAD stenosis 1.5mm by soft plaque
3. Normal coronary arteries elsewhere.
I see my cardiologist in 2 wks. Should I be concerned about the stenosis? Would you stent this area? what are my options. Many thanks for any information.
In general stenosis is not flow limiting in the coronary system unless it is 70-80%. Why was the test done in the first place? If you have no symptoms i suspect that medical treatment is advised since the stress test was negative.
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Thank you for your reply. Test done for some soboe [walking up small inclines], IHD fx and menopausal symptoms of fatigue etc. The stress ecg showed 1.0 mm of horizontal ST segment depression changes in Lead 1,11 and aVF during the peak stress period. I got to IV of the Bruce treadmill and stopped for fatigue. No chest pain ever. Your info above is encouraging – I was thinking heart grafts etc!! Maggie
ps. do statins reduce the plaque or prevent it worsening.
The next best step in your case may be some form of stress test with imaging, i.e nuclear stress or stress echo. This helps to determine the physiologic significance of the lesion in the setting of symptoms and help determine risk. Statins are thought to reduce the chance of a significant event in people with cardiovascular disease. Its very reassuring that you exercised to a good level on the treadmill test.
Hello again and thank you for your insight. I did have a post exercise stress echo and now have the results: which showed wall motion: appropriate global augmentation of L ventricular systolic function post exercise with no inducible myocardial ischaemia detected. But I do have stenosis or narrowing which possible could get worse. I also feel afraid to push exercise incase I blow the artery!!
Hello Dr.Ahmed. my dad is of 53 now. Three days back he had angina.so v had visited Dr had undergone many tests lastly through angiography he is detected with rca 80% blockage and lcx 90%.. doctor had said for angioplasty. my question is angioplasty is necessary ??
Hello Dr.Ahmed. my dad is of 53 now. Three days back he had angina.so v had visited Dr had undergone many tests lastly through angiography he is detected with rca 80% blockage and lcx 90%.. doctor had said for angioplasty. His sugar level after food is 163. He won’t smoke or drink. Is angioplasty is necessary ?? Will his life span increases ??please Dr reply to my comment,it’s my sincere request to you.
Since he has symptoms and 2 known critical lesions treatment may be needed with stents or other intervention, a lot depends on his risk profile and clinical status also.
I was having chest pains and short of breath at times. I had a stress test and an echo test done. The doctor said that I failed the stress test and there was not normal blood flow at the tip bottom of my heart. She recommends a cath be done and a stent put in. I am not sure if this is really going to cure me or nothing. Thanks, Ron
Hi. I have a number of cardiac problems, possibly due to inflammation from Stage 3 COPD and GERD and Osteoarthritis. An echocardiogram earlier this year showed a number of conduction problems including 1. incomplete right bundle branch block, 2. left posterior fascicular block, 3. atrial extrasystoles, and 4. sinus arrhythmia. I then had an angiogram in August that showed severe LAD and moderate LCX coronary artery blockages. My cholesterol is only slightly high, and my blood pressure and BMI are low. Now that I’m on beta blockers my resting heart rate is around 50bpm. I also suffer from Central Sleep Apnea, and due to a combination of the sleep apnea and the COPD my nocturnal oxygenation drops as low as 82%. My normal resting oxygen levels is around 92 to 93%. My question is will having a stent put in my LAD artery effect the conduction heart blocks? It doesn’t seem as if a LAD blockage is usually linked with a left posterior fascicular block but I could be wrong. Also does having a stent in a severely blocked LAD artery increase your body oxygen levels, as measured by a pulse oximeter, or just the oxygen levels to the left side of the heart muscle? After reading the above article I’m rethinking booking a stent operation unless it will increase my body oxygen levels.
Can you have a severe heart attack and not have any damage to your heart muscle or did I misunderstand my doctor? I’m a 56-year-old male and had a heart attack conditions for 6 hours and took 4 low dosage aspirin and antacids prior going to the hospital. I had an emergency 40% stent procedure and released the next day feeling alright with only a little discomfort.
If the procedure is done in time in the setting of an acute heart attack, damage can be aborted significantly.
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I’m 54, stent put in on Nov28. Opened a RCA 99% blockage. Good healthy habits, non smoker and 6-3, 210. Does this event generally mean a certain shortened lifespan?
Not necessarily.
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Doctor
Over the past several months I’ve had a random arrhythmia, most of the time during exercise, but not always. I have had echo, and nuclear tread mill tests, I have worn 3 different types of heart monitoring devices and no arrhythmia, but the next day I did have an episode. Durning these episodes I’m aware of an irregular heart beat, and I’m aware of diminished physical capacity, but I have no pain.
Could this be symptoms of an artery blockage?
Not possible to answer such a question over such a platform however the tests you have had are reassuring it sounds. Have you tried a longer monitor to catch the arrhythmia and characterize it.
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Stent placed 3 weeks ago because of 90 percent blockage, started cardiac rehabilitation last week and would rather be outside running in the cold.How long do have to wait, Also taking Protonix along with other meds. I don’t have any heartburn, can I ask cardiologist to take me of it,
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 (HR) 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 agresively (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. The reccomendation is to cath/possibly stent.
Also, I am very much contemplating the issue whether or not to stent if there is an agressive 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
A few things,
It depends who did the test. When i do tests i always push people as hard as possible safely, this ensures maximal information and reproducibility over time. In general the goal is to reach 80% of predicted max. The test findings show a relatively low risk finding of mild to moderate ischemia. Depending on the situation i would generally offer my patients a chance to try medical therapy with lifestyle modification and see if symptoms settle. Why did you have the test in the first place? If it was not due to symptoms then its questionable to proceed to cath in the absence of moderate to high risk features. These findings are worth discussing with your provider.
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Hi Dr Mustafa Ahmed
My husband is 47 years old, he is diabetic & High BP. Few days back he had 2 stents placed in his arteries, and the doctor said that he as 4 more blockages, but did not put stent on it, we all are in shock. He is been prescribed with lipitor, plavix, aspirin and diabetic and bp medicines. My question is we are vegetarian, and he doesnt smoke, or consume alcohol. Is this because of too many medications or due to cholesterol? Is the plaque reverse able?
Thanks
Diabetes is likely the main culprit. Its critical that is treated well and then there is some hope for the medicines stabilizing the disease.
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Dear Dr Mustafa Ahmed,
I have had known CAD since diagnosis in 2003. I have never taken medication for this, except a small dose of aspirin a few weeks back. In December I pulled out a Kitchen and loaded a 9 cuM waste skip and was throwing large blocks. Some months later I had difficulty breathing while lying on my back and this put me in hospital overnight. My cholesterol is around 8mmol/L. My Mother has high cholesterol but has known Hashimoto’s disease. My Father had a heart attack at 74ys but had low cholesterol. I recently had a Heart CTScan and I have learnt today that there is a blockage-the degree at this stage and area I do not know. I am due to fly to England from New Zealand on 19th June 2018 and then back again after about 5 weeks. This is to see my family and friends. I have an appointment with my GP on morning of 19th to discuss the situation and I know there will be pressure on me to have a stent ( I need to know what the lesion entails. I will be discussing medication around anti-clotting and I will take this. I have to make a decision, but I am trying to give myself a heads up on the risks for flying. Is there any credible guidance? I know about the clotting, dehydration ( so no alcohol), movement and reduced oxygenation on the flight. I have improved recently ( in the last few weeks)in terms of symptoms of breathing while lying down- no real symptoms. I cut back on my hours at work and did more exercise and eating earlier. I had a massage last night and this made me worse and I now realize that the massage overloaded the heart possibly through Starlings Law of the Heart factor. I am cautious in terms of a knee jerk reaction to having a Stent inserted. Are you able to point me in the direction of more reading. Many thanks
In terms of the flight, the safe thing would be to see a Dr and be evaluated ans risk stratified prior to flying, essentially to determine the stability of the symptoms.
Here is the link to an article i have written on the subject a few years ago.
https://www.al.com/living/index.ssf/2015/02/is_it_safe_to_fly_if_i_have_a.html
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I have COPD and ten years ago had a stent put in. My breathing recently got worst and my heart doctor had me take a nuclear stress test which showed I might have a blockage. No angiogram was done. He just wants to go in and check for blockage with a stent ready to insert. I have no chest pains. Should I even consider having a stent put in?
Depends on the extent and stability of the symptoms, the severity of the stress test in some cases and the response of the symptoms to medication.
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Hello doctor how can you classify the patient’s if he is high risk when he is stable and has no symptoms ?
If the patient’s has blockage in the lad 70% and digonal branch lesion 70 to 90 %
And had a stent in rcx aftet small maycordial infection thr rcx was blocked 100%
Do you coniseder this case high risk there for stent is necessiry for the land and the lesion in the digonal?
It’s not really possible to answer this without seeing the images and knowing the history in detail. It also depends on the function of the heart, the clinical state of the patientb and the appearance of the artery.
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I read your article and I had stent a one year back at RTCA with report of 90% block . But now I am thinking after reading your article , we did mistake having stent . We could have tried initially with medicine . But doctor compelled to my wife to have stent . But I was on against at that time . But finally I was placed . Now I am diabetic patient in a control with HbA1C is 5.7 . Please advise whether the placing the stent is correct ? what must have done ?
Did your symptoms improve?
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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 Good Doctor.
May ask a simple question? Your professional opinion would be greatly appreciated.
Why is it when us “average” people who have high CAC scores and family history and are at high risk for heart attacks, you cardiologists tell us there is nothing you can do if we are not having symptoms. Yet when a celeb like David Letterman had no symptoms, but was worried about his heart due to his father dying in his 50’s from a heart attack.. he was able to get the gold standard in care, a “precautionary” angiogram, which, according to his doctors lead to his life-saving quintuple-bypass hours later? Wouldn’t the same prudent precautionary invasive examination benefit us “little people” too? I’m only 54 years old and have a CAC over 1200, I have a sibling and father who both died heart attacks, yet my family doctor and cardiologist tell me because I’m asymptomatic they can’t justify invasive testing. I don’t understand. What if I. like Letterman, had extensively blocked arteries, but no symptoms… I have to play Russian roulette, but our “betters” get a new lease on life?
Thank you,
Gary Meadows
NYC
https://myheart.net/articles/ct-coronary-artery-calcium-heart-scan-the-facts/
See if this is helpful.
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.