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The LAD Artery

The LAD Artery

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LAD stands for left anterior descending artery. It is a coronary artery, which is the name given to arteries that supply the heart muscle with blood. The LAD is considered the most important of the three main coronary arteries and is almost always the largest. It’s called the LAD because is on the left side of the heart (left) it runs down the front wall of the heart (anterior descending). The Left anterior descending artery typically supplies over half of the heart muscle with blood, so twice as much as the other coronary arteries. For this reason, a major blockage at the beginning of the artery is often known as the Widowmaker!

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LAD artery

Branches of the LAD artery

The LAD gives rise to septal branches and diagonal branches. The septal branches of the left anterior descending supply the septum, which is the wall between the left and right main pumping chambers of the heart. The diagonal branches of the LAD supply the front to sidewall of the heart. Basically the LAD covers a large area! Over 99% of people have at least one diagonal branch of the left anterior descending artery. In about 80% of people, the LAD wraps around the bottom of the heart and supplies the area beyond that.

Blockage of the LAD artery

Thoracic Aortic Aneurysm

Significant blockages of the LAD artery can be dangerous simply because the LAD supplies such a large territory. A stemi heart attack involving the LAD is typically more serious than other heart attacks. Usually a blockage of the LAD artery has to be more than 70% to cause significant problems. Even when it looks 70% blocked, more sophisticated tests are often used to determine whether a procedure is required to treat it. It’s now well accepted that a visual estimate of blockage is not a good way of determining how severe the disease it.

If the LAD disease is determined to be significant then a stent is often used to relieve the blockage. Sometimes bypass surgery is advised, and usually a vessel called the LIMA (left internal mammary artery) is used as the bypass vessel and is associated with very good long-term results. Sometimes, if the blockage is towards the end of the artery, medicines alone may be advised.

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Comments are purely for informational purposes and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Disclaimer

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Comments

  1. Hi,

    I had a heart attack two weeks ago and they were able to put a stent on the RCA but not my LAD artery due to the spot of the blockage. The doctor said that my LAD is 60% blocked and I will need open heart surgery. What are your thoughts on this?

    Thank you so much

    Reply

    • They never treated my father with CABA although numerous things pointed to that being the only way my father was to survive! He had his first heart attack in 2003 , LAD , they placed 2 stents then went back and stented RCA. He had another in 2007, again, another stent. Last February , one of the LAD stents was occluded and , again, another stent. He died from that same , exact blockage and the LAD 2 weeks ago at the age of 68. They didn’t want to perfrom the CABG during the first heart attack because of his age , he was 55. They continued to allow the damage to be done and as a result, he did not make it. This all could have been prevented with the LIMA bypass of the LAD. The LAD supplies the a large area of the heart and if a blockage occurs, the death could be sudden. I would ask for a second opinion but please research this carefully. Although, having the procedure is risky numerous people have that done every year and it would have been the life saving measure my father needed. He was still working, running his own business and traveling frequently. Also please keep in mind, that each subsequent heart attack does a little damage each time, effecting your overall ejection fraction of your heart muscle. Please don’t allow them to deter you or put you off the stents are not 100% and you need to do everything possible, IT your life and it doesn’t effect them.. Good luck!

      Reply

      • Kim, I am sorry for your loss. This should not of happened. Thank You for your words of wisdom.
        I am in this same boat now. Was told no one gets just one artery, bypass. This is crazy. If they had done bypass on my LAD when I was coding, I would not of had a Massive STEMI three weeks later and now in severe heart failure. What is wrong with some of these doctors!! Not all hospitals are equipped with good interventionalist that can call in a Thoracic surgeon instead of trying to “see” if they can stent it. Before the novice doctor threatened me with death if I did not allow him to stent me, we asked to be transferred 20 minutes away via ambulance to the Heart center. His threat of me dying in 20 minutes put the fear of God in me. I am paying the price for his ignorance now. My EF is in the cellar. They want to do another Heart Cath to see what is going on in my LAD that may attribute to the EF going south. God Bless those of us suffering with HD.

        Reply

        • Hi Ive had Heart Failure and now have an enlarged heart with a scare on my heart which basically that part wont work. They couldnt give me a reason why it occurred BUT today I when in for an angiogram and find out there is a servere lession of LAD and instead of fixing it they are booking me in for a double stent as its at a place where two go into one. Im now thinking the reason I had the heart failure was there was already a problem and they should of fixed it 3 years ago than let me go on trying to get on with my life. Also read that this LAD supplies areas of the heart that also supplies blood for the part of the heart that controls the rhythm also they told me the left valve wasnt working well again this is an area that is supplied by the same. They told me 3 years ago that there were illregularities just think they should of sorted it then and not let me have a mild heart attack this time. Also wondering about a by pass instead of stents as I know depending on type they are not all that succesful in long term. Was also thinking in past was probably better that I had heart failure than heart attack and have to have stents little did I know that a blockage was the probable cause for heart failure by my way of thinking about it.

          Reply

          • Mam I am on same boat I M 38yrs now got first stunt in 2016 in LAD I use to be alholic being elder son in family life is and was stressed, SAME STUNT GOT 100% BLOCKED IN 2018 DOCTOR WANT TWO STUNT TO BE INSERTED IN PREVIOUS ONE, I GOT SCARED AND TAKEN NATUROPATHY AYURVEDIC MEDICINE IN ONE GO ALONG WITH DOCTOR PRESCRIBED ALLOPATHIC MEDICINE JUST GOT MY CT.ANGIONGRAM NOW REPORTS SAYS LAD STUNT IS 70%TO80% BLOCKED AS I HAVE LOST TRUST IN DOCTORS JUST TRUSTING IN MY GOD BUT SCARED CAN ANYONE SUGGEST ME WHAT TO DO AS I WANT TO LIVE CAN’T AFFORD TO SEE MY KIDS ORPHANS HELP IF ANYONE CAN JUST NEED ADVISE

        • Lisa, i read your reply saying you were told no1 gets a single bypass. The dr who told you this is wrong. I had a heart attack (the widow maker) 3AM on May 21, 2017. I was 36yrs old at the time. I went into the hosp. They ran tests all day and on day 2 did a heart cath and determined my proximal lad was 90% blocked. The drs suggestion was to have a single bypass with LIMA. He stated that where the blockage was that stents were a bad idea and a CABG with LIMA was the best option. And the survival rate was greater with cabg w/lima then with stents. He told me stents often fail in future but for some are the faster n better option. I had my surgery on the 26th of may. Im feeling good and was told i should live a normal life. And so, the beat goes on. Heres to all the heart warriors out there.

          Reply

          • Hi Lisa, were you symptomatic before your heart attack? did you do a stress test that showed ischemia of the LAD?

        • I have stents 4 of them, went in the hospital a week ago then to my heart doctor he told me i was fine if i was not having any more pain and had been walking for 20 to 30 minutes a day but one Wednesday night we came home and i had a very hard tump in the left side of my chest later that night i had another went to hospital but my doctor thinks I’m ok but i don’t feel well. I’m very afraid so I’m going tomorrow if i live to try and get a second appenion.

          Reply

      • I’m so sorry to hear about your father. Doctors made some similarly stupid decisions in my father’s case. I have zero faith in cardiologists.

        Reply

      • Hi I am a 55 yr old female and have normal bmi, non-smoker. No history of diabetes or htn. I had 5 blockages in 3 vessels with an MI. I had heart bipass × 2 in march 2018. I ate well and exercised. Unfortunately only 2 out of 3 blockages in lad could be bipassed. The 3rd distal blockage could not be fixed. I now have problems with my native artery competing with the bipass graft. It hasn’t even been one year and the bipass is 50 percent stenosed and it caused more problems than good.

        Reply

    • thank i have old complete LAD block
      now i feel easily fatiqability and chest pain
      on emotional stress…..what do sugest

      Reply

      • Yep go to emergency with any chest pain I was telling my doctor I was getting chest pain eventually had mild heart attack. For fatigue if blood is not flowing well then you will get fatigued which again better to have it looked at than not. After that I was taking a high does of statin and I was sleeping my life away so changed to a different one. Also before heart failure and mild heart attack I was more sensitive to emotional up sets and would get chest pain when talking about something that was upsetting Again all signs that something serious is happening and you need to get to emergency

        Reply

      • In stable diseases it is not generally felt to be an issue, most would say check with a physician first, some of the donation organizations have rules such as a need for a certain time to have passed since treatment and stable medication over that time.

        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.

        Reply

  2. After Nuclear test and imaging two months ago my Cardiologist said that there is a small blockage in the left descending artery and we will do an Angiogram in March of next year. I feel uncomfortable that he did not do it then. I had open heart surgery 31 years ago for 93% of blockage of the same artery. My Doctor is a good Specialist and he is thinking that it is small, so we can wait. However, he says always, if you feel shortness of breath or Angina, call immediately and we will do an angiogram. What is your hunch on this matter and any suggestion is welcome.

    Thank you

    Please reply

    Reply

    • Hi, it sounds like your test showed a small blockage likely only which is reassuring. It all depends on your symptoms and why the test was done in the first place. If you are having symptoms and a test suggests you need an angiogram i don’t understand the wait till March. If the stress test is low risk and you have no symptoms or reason for an angiogram then one shouldn’t be done. I would ask your Dr. what group you fit in to. There are very few times i would schedule an angiogram to be done in 3 months time. It either needs doing or it doesn’t and that depends on risk and symptoms.

      Reply

      • Sorry to interrupt the thread. My mom just had a stent for LAD blockage. Doctor said the artery was damaged during the procedure. Then they said they had to put a longer stent to cover the tear and rupture. After the procedure the doctor said there’s no leakage and perfusion and blood flow was normal.I just want to know is there anything we need to worry about this rupture vessel. Will she need CABG? So far doctor didn’t say anything about Bypass surgery. We are very worried now since the stent procedure had rupture complication. Thanks in advance.

        Reply

        • It sounds like she may have had a dissection of the vessel and or a perforation that was taken care of by covering the affected area with the stent. If the area was treated adequately with a stent it generally solves the issue and surgery isn’t required.

          you can follow my twitter at @MustafaAhmedMD

          Reply

          • Hi dr,
            My dad is 59 years old .his angiography results are as follows -LAD 99 percent block and 80percent block in circumflex,would you please advise should we go for angioplasty or bypass ,
            Thanks and regards,
            Mital

          • This needs to be determined by the treating Dr. I cant really comment without clinical evaluation and review of the films.

      • Hi Doctor ,
        I am 45 years old , I had a myocardial infarction two months ago , I went to a small unequipped hospital 30 minutes post chest pain , I recieved dinitra tab beneath my tongue and Aspirin 300 mg …after one hour I went to a big hospital and the cardiologist advised me to perform angioplasty ASAP , I did it 5 hours post chest pain , tlhe cardiologist told me that it is a diagnostic angipoplasty , no need to put a stent.
        After that , my CT coronary and angioplasty showed that i have two ectatic vessels , the proximal segments of LAD & LCX …plus completely occluded Diagonal 2 branch .
        My cardiolgist advice to take medication including Antihypertensive agent ( Exforg 5/160 mg ) , Aspirin 100 mg , Plavix 75 mg , Lipitor 40 mg all are once daily and finally Vastrel MR twice daily …
        At the same time with medication he advised me to stop smoking , change life style , one hour daily excercise even walking , low fat diet , dont do a great efforts …
        Now , I am stick to all these instruction since two months except stop smoking , I feel good , there is no symptoms , some rare times I feel uncofortable , but I did my stress test and echo and it is fine .
        please advise , still I feel that
        انا مش انا قبل وبعد الجلطة .
        والحمد لله رب العالمين ..
        انا فى نعمة بفضل الله
        Thank you

        Reply

    • I work in a cath lab as a nurse. The stent itself can cause problems with blockages so we really only want to use a stent when the blockage is severe. The bodies natural instinct is to attack foreign object placed in the body which is why clots are an issue post stent. The body will send platelets to the stent sight to protect the body and encapsulate it. Meanwhile, the platelets are causing a blockage. It sounds like your dr is trying to be conservative which is a good thing.

      Reply

      • I’m confused by your comment, isnt a bypass usually needed when the patient has severe blockages? I ask this because my grandfather was just diagnosed with severe 3-Vessel CAD. He was in the hospital having surgery to remove colon cancer and had a heart attack a few days later. The cardiologist performed a cardiac cath and told us he didn’t put any stents in because he has numerous severe blockages. They recommended a bypass which is what he will be having next month.

        Reply

  3. Why would a blockage develop in such a large vessel rather than in one of its subs? Is there something going on in the whole of the system that is causing a blockage to form in the LAD? Something dietary or behavioral or genetic? Has anyone conducted studies that explore correlations between common areas of blockage such as ‘high in the LAD’ and other characteristics / attributes of demographics? Thank you

    Reply

    • A blockage occurs in specific areas and severe, rapid onset of symptoms most often results from a rupture in the plaque lining the vessels that attracts platelets. Platelets are a component of the blood that responds to the site of percieved injury. It isn’t an issue of how large the vessel is, the issue is the specific place that the rupture occurs. If a blockage slows or stops blood flow a clot can form, but the hear attack itself is not often caused by an actual clot as much as the collection of platelets. There are some conditions where a clot can travel into the coronary ateries though.

      Reply

  4. My Father had a heart attack , he was admitted in hospital and was on medicines for two days.
    heart EF showed 35% , and trop i was 26. doctor asked to angiogram followed by angioplasty
    he was not agreeing but the doctor made him agree to do that.
    angiogram showed blocked mid LAD and suggested a stent to be placed. he did that and told the block was very hard to penetrate it took two wires to do that.
    he placed a drug eluting stent.
    but after few hours he became hypotensive and started shortness of breath. Doctor had no idea what is happening and he was dead within few hours.
    not sure it was thromosis or temponade.
    my question is my father was totally fine and was walking, talking and eating well for two days after heart attack. why did the doctor did not think of keeping him on cardiac meds?
    He could have been alive.?

    Reply

    • Very sorry for your loss. I would start by going and talking to the Dr that did the case to explain the reasoning so you can have a more clear picture of what happened and why that management plan was chosen. These situations are often very complex and vary hugely from patient to patient.

      Reply

  5. my husband didn’t go to the doctor for 12 years. finally went and was dead a month later. he didn’t feel well. had high blood pressure and high cholesterol. he was also 50 pounds overweight. heart disease, stent and open heart surgery in his family. doctor put him on aspirin, blood pressure med. he also had a stress test, ekg and echocardiogram. was told he passed. 2 weeks later massive heart attack and died on the spot. would have any of these tests shown a blockage? was it missed in the reading??
    sad with so many questions,
    thank you

    Reply

  6. My husband had chest pain which we mistook for gastric acidity. Two days later we went to hospital he did an ECG which was abnormal and triponin levels were up at 1680. An angiogram was done which showed a LAD occlusion. An echo was done showing significant left ventricular systolic dysfunction with an ejection fraction of 30% and mild valvular regurgitation (mitral) as well as small pericardial effusion. The doctor regarded it as late presentation and immediate intervention to the LAD was now considered inappropriate. NM REST MYOCARDIAL PERFUSION and MRI CHEST Was done.
    Examination: NM REST MYOCARDIAL PERFUSION
    Date of exam: 26/01/2016
    Addendum:
    The small area with significant viable myocardium in the distal septum involves less than 5% of the LV myocardium.
    -Addendum end———————————————–CLINICAL INFORMATION: LAD infarct.

    TECHNIQUE:

    1113 MBq of 99mTc – Tetrofosmin were injected at rest and a gated SPECT study acquired one hour later.

    FINDINGS:

    The left ventricle is enlarged.

    The perfusion study reveals a large area of infarction in the apex and the anteroseptal wall.

    A small area of viability is seen in the distal septal wall within the area of the infarct.

    COMMENTS:

    Large infarct in the apex and the anteroseptal wall with a small area of viability within it in the distal septal wall.

    RADIOLOGY DEPARTMENT
    Examination: MRI CHEST
    Date of exam: 27/01/2016

    Cardiac MRI: Function and Viability
    Clinical information a 48-year-old male patient with acute coronary syndrome. Occlusion of the LAD
    Comparison
    Findings
    Left ventricular measurements
    End Diastolic Diameter: 56 mm (normal, 36-56 mm
    Ejection Fraction: 40 % (normal: male = 56-78%; female = 56-78%
    Stroke Volume: 53 mL
    End Diastolic Volume: 131 mL (normal: male = 77-195 mL; female = 52-141 mL)
    End Systolic Volume: 79 mL (normal: male = 19-72 mL; female = 13-51 mL)
    Cardiac output: 4.4 L/min (normal: male = 2.82-8.82 L/min; female = 2.7-6.0 l/min)
    Left ventricle regional wall motion
    Akinesia of the anteroseptal wall extending to the apex is seen.
    Left ventricle myocardial enhancement
    Delayed enhancement is seen in the anteroseptal wall and apex with evidence of microvascular obstruction.
    Non-cardiac findings:
    No relevant findings are seen.

    Impression

    Global systolic LV function: Poor
    Global systolic RV function: Normal
    LV viability: Large Myocardial infarction involving the anteroseptal wall and apex with evidence of microvascular obstruction. The patient is unlikely to benefit from revascularisation.

    Do you think opening the totally occluded LAD artery would be of much benefit or would leaving him on conservative line of treatment be better. As there is a small area of viable myocardium. Would performing angioplasty to open up the LAD artery be of any benefit as the reports seem to suggest a very small area of viable myocardium in the infarcted anterior segment. Transmural Infarct more than 50 % of the septum.
    Involving 20 % of the left ventricle anterior myocardial Wall.

    Reply

      • I had 5-way CABG in 1996, and in 2014 I had to go for another by pass operation. My surgeon managed to by-pass just one of the occluded ( again!) 5 arteries. Prior to the operation he was optimistic that he would be able to also by pass my LAD. However, he could not isolate or find my LAD !! Is this possible ? Are there any techniques to locate an LAD ?

        Reply

      • I am 55 Asian man with normal blood pressure and cholesterol level. I have been relatively fit (slightly over weight) and never smoked or drink. I do have family history of heart problems. I had abnormal EKG and stress test 2 years ago. With my stubbornness, I believed that I could keep my current status through healthy living and medication. Finally, my doctor convinced me to do a catheterization. The results show that I have 50% to 60% blockage in left main artery, 95% in left circumflex, 100% in right coronary, and 80% in posterior descending artery. No damages to the heart muscle through. One doctor recommend bypass and the other recommended stent for the 95% left circumflex + medication. I like to hear more options and recommendations. Thank you very much.

        Reply

        • Its difficult to comment without seeing the films, however in any such situation i feel that opinion should be sought from both surgeon and interventional cardiologist and an appropriate decision made with the pro and con of either approach being considered. This is known as a heart team approach and should be standard in all centers of excellence. There are may situations in which there is a clear preference between the approached, dependent on the clinical situation. Also its important to note that although a procedure or operation may be required, you are spot on in that healthy living and medication are at least as important in determining your long term outcome.

          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

          Reply

          • I survived a massive heart attack in 2001. I was 99% + LAD blockage after a 8+ hour delay due to the original misdiagnosis. I expect it was missed due to my age (36), health, non smoker, vegetarian and the lack of any family history.

            They chose intervention as opposed to CABG due to the significant damage and little to no chance of survivability. After 17 stents and countless additional cardiac caths in 7 1/2 years, declining function and no room for additional stents I made the decision to undergo CABG and against odds survived. In addition to the extensive plumbing and CABG I also rely on a BV pacemaker defibrillator, 3 to date along with multiple RX’s. I am at maximum therapeutical dosage on applicable medications.

            As in my case sometimes CABG may not be an option depending on the patients condition in acute conditions. I would also like to mention that my MI was stress related, which is seldom mentioned as appears to be the case in this forum. I have witnessed far to many stress related heart attacks during my nearly 17 years of being a cardiac poster child. Nearly a decade ago I witnessed a fatal heart attack of a 19 year old male. I’ve also seen cardiac patients decline in age, it’s common to see patients in their 40s. I would like to see the opinion of a Cardiologist and or healthcare provider opinion on age trends and stress.

            I also feel incumbent as a cardiac patient and heart attack survivor to try to share my stories with other in hope that it might make a person proactive rather than wait and spend their life as a statistic. Taking this advocate roll has been therapeutic and helped this life changing event worth it.

          • Hello all,

            I am at a crossroad myself, I am 56 years old and had a first heart attack in 2006 in the RCA area , I recovered quickly and the Dr said it was mild and was started on statins at that time. On October 6th 2017 I went to the hospital with chest pain that went away while in the emergency room. Normal blood pressure and a normal EKG at this time, My doctor recommended a LHC and I agreed to have this procedure….as I was moved on to the table the chest pains came on very strong and I had a 100% blockage in the CIRC that was stented. Since the hospital and my long time Dr. were no longer on our insurance he recommended another Dr. since it was noted that there was another blockage in the RCA that needed a stent . So a new Dr. that came recommended from a friend. I was admitted to the hospital and later that day a stent was placed in the RCA and I was sent back to the room to recover. The last two procedures were radial and the first one by groin. The next morning the Dr. (new) came in to the room and told my wife and I that he did not feel satisfied with the stent and how much he was able to balloon the area since he was able to open just 70% and wanted to go in with a larger balloon. To my dissatisfaction I agreed, here we go 3 LHC’s in 3 weeks! the next morning the procedure started and once in the Dr. stopped the procedure about 10-15 mins in to it. He came to my side and said I needed bypass surgery and a surgeon would come to my room to consult me. I was devastated…..He said I had a 50% blockage in the LAD. The confident surgeon came to my room and said I was critical and needed the surgery right away and I could stay in the hospital (a Tuesday) and I will schedule Monday. I said wait how critical am I? he said if you were my brother I would do it Friday but you are taking brillianta and need it out of your system. I told him I will go home to get things in order and come back Sunday ….As I was leaving the hospital I called my original Dr. and he went nutz on me and asked for the test results…and for me to come to his office tomorrow. during this appt he said I find no results from your tests that show you need open heart surgery and I don’t want you to have it! come in tomorrow and bring the ECHO results as well, need to do a stress test. I ran for 9 minutes with no symptoms and a normal EKG. I received a call from the Open Heart Surgeon since I cancelled the surgery. He told me that I had a very critical heart disease and need the operation desperately since I could drop dead at any minute, this was very upsetting and let my original DR> know, he apologized for his behavior and said this Dr just treats these things differently, he showed me my ECHO with an EF of 55. I am scheduled for a Nuclear Stress Test to see if the LAD lights up…if it does I have agreed to stent it. I have two very qualified Dr.’s with opinions at two different parts of a spectrum! I am seeking a 3rd opinion in Austin Texas later this month after the stress test. I feel strong no symptoms but this has affected my mind thinking I am going to drop dead at any second…….I hope others don’t have to go thru this….

  7. Many thanks Jazakallahu kheir for your answer however kindly advise
    1. which medication will he have to use for life time- taking in mind he is only 48 years old.
    2. Can he lead a normal lifestyle other than watching his diet and being physically active with exercises.
    3. Are his chances of a recurrence of an MI higher than any other individual
    4. At what level should we work at getting his ejection fraction be?
    5. What preventive measures should be taken?

    Reply

  8. Hi I am 71 year old male I had heart attack 10 days ago. LAD total cut and CX too. EF25%. What’s can I do? Cabg or stent apex totally necrosed

    Reply

    • Often further tests such as viability tests are done in this setting to see if patients may benefit from bypass or stenting, in your case bypass would appear the most likely option with the limited information provided and a viability test would given an idea to see if the tissue is still alive.

      Reply

      • 100% blockage of my LDA, near the lower tip of my heart. Viability test showed minimal results if stented. Medication was my choice. I also have an aneurysm. It’s been 4 years and i’m still here. No symptoms or pain, I guess I am lucky, Dr. said it has been at least a decade since the blockage. I never realized I had a heart attack.

        I began a year long course of Keladine cream…snake oil, I know but you tend to grasp at staws.

        Anyways, i’m hoping to last some more years. I have my ducks in a row…in case!

        They recommend exercise, but I am apprehension. You always hear about athletes collapsing. So I am taking it easy, God willing I will survive.

        Thanks,

        Dan

        Reply

        • Trust GOD shows long lead of life to you. Can u say what are all the medicines u take in a day . Just like to know since LVEF 20 % case is what is mine and had an Angioplastry

          Reply

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    The LAD Artery
    The LAD Artery
    February 11, 2015 5648 0
    Dr. Mustafa Ahmed

    LAD stands for left anterior descending artery. It is a coronary artery, which is the name given to arteries that supply the heart muscle with blood. The LAD is considered the most important of the three main coronary arteries and is almost always the largest. It’s called the LAD because is on the left side of the heart (left) it runs down the front wall of the heart (anterior descending). The Left anterior descending artery typically supplies over half of the heart muscle with blood, so twice as much as the other coronary arteries. For this reason, a major blockage at the beginning of the artery is often known as the Widowmaker!

    LAD artery
    Branches of the LAD artery
    The LAD gives rise to septal branches and diagonal branches. The septal branches of the left anterior descending supply the septum, which is the wall between the left and right main pumping chambers of the heart. The diagonal branches of the LAD supply the front to sidewall of the heart. Basically the LAD covers a large area! Over 99% of people have at least one diagonal branch of the left anterior descending artery. In about 80% of people, the LAD wraps around the bottom of the heart and supplies the area beyond that.

    Blockage of the LAD artery
    Thoracic Aortic Aneurysm
    Significant blockages of the LAD artery can be dangerous simply because the LAD supplies such a large territory. A stemi heart attack involving the LAD is typically more serious than other heart attacks. Usually a blockage of the LAD artery has to be more than 70% to cause significant problems. Even when it looks 70% blocked, more sophisticated tests are often used to determine whether a procedure is required to treat it. It’s now well accepted that a visual estimate of blockage is not a good way of determining how severe the disease it.

    If the LAD disease is determined to be significant then a stent is often used to relieve the blockage. Sometimes bypass surgery is advised, and usually a vessel called the LIMA (left internal mammary artery) is used as the bypass vessel and is associated with very good long-term results. Sometimes, if the blockage is towards the end of the artery, medicines alone may be advised.

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    Comments
    Mary Varsalona says
    April 25, 2015 at 1:41 pm
    Hi,

    I had a heart attack two weeks ago and they were able to put a stent on the RCA but not my LAD artery due to the spot of the blockage. The doctor said that my LAD is 60% blocked and I will need open heart surgery. What are your thoughts on this?

    Thank you so much

    Reply
    Belwady Murthy says
    December 27, 2015 at 12:53 am
    After Nuclear test and imaging two months ago my Cardiologist said that there is a small blockage in the left descending artery and we will do an Angiogram in March of next year. I feel uncomfortable that he did not do it then. I had open heart surgery 31 years ago for 93% of blockage of the same artery. My Doctor is a good Specialist and he is thinking that it is small, so we can wait. However, he says always, if you feel shortness of breath or Angina, call immediately and we will do an angiogram. What is your hunch on this matter and any suggestion is welcome.

    Thank you

    Please reply

    Reply
    Dr. Mustafa Ahmed says
    December 29, 2015 at 2:12 am
    Hi, it sounds like your test showed a small blockage likely only which is reassuring. It all depends on your symptoms and why the test was done in the first place. If you are having symptoms and a test suggests you need an angiogram i don’t understand the wait till March. If the stress test is low risk and you have no symptoms or reason for an angiogram then one shouldn’t be done. I would ask your Dr. what group you fit in to. There are very few times i would schedule an angiogram to be done in 3 months time. It either needs doing or it doesn’t and that depends on risk and symptoms.

    Reply
    David Boulton says
    January 4, 2016 at 2:49 pm
    Why would a blockage develop in such a large vessel rather than in one of its subs? Is there something going on in the whole of the system that is causing a blockage to form in the LAD? Something dietary or behavioral or genetic? Has anyone conducted studies that explore correlations between common areas of blockage such as ‘high in the LAD’ and other characteristics / attributes of demographics? Thank you

    Reply
    uday says
    January 25, 2016 at 10:01 am
    My Father had a heart attack , he was admitted in hospital and was on medicines for two days.
    heart EF showed 35% , and trop i was 26. doctor asked to angiogram followed by angioplasty
    he was not agreeing but the doctor made him agree to do that.
    angiogram showed blocked mid LAD and suggested a stent to be placed. he did that and told the block was very hard to penetrate it took two wires to do that.
    he placed a drug eluting stent.
    but after few hours he became hypotensive and started shortness of breath. Doctor had no idea what is happening and he was dead within few hours.
    not sure it was thromosis or temponade.
    my question is my father was totally fine and was walking, talking and eating well for two days after heart attack. why did the doctor did not think of keeping him on cardiac meds?
    He could have been alive.?

    Reply
    Dr. Mustafa Ahmed says
    January 26, 2016 at 5:59 am
    Very sorry for your loss. I would start by going and talking to the Dr that did the case to explain the reasoning so you can have a more clear picture of what happened and why that management plan was chosen. These situations are often very complex and vary hugely from patient to patient.

    Reply
    lisa says
    February 7, 2016 at 8:47 pm
    my husband didn’t go to the doctor for 12 years. finally went and was dead a month later. he didn’t feel well. had high blood pressure and high cholesterol. he was also 50 pounds overweight. heart disease, stent and open heart surgery in his family. doctor put him on aspirin, blood pressure med. he also had a stress test, ekg and echocardiogram. was told he passed. 2 weeks later massive heart attack and died on the spot. would have any of these tests shown a blockage? was it missed in the reading??
    sad with so many questions,
    thank you

    Reply
    Iyman sherman says
    February 28, 2016 at 9:02 am
    My husband had chest pain which we mistook for gastric acidity. Two days later we went to hospital he did an ECG which was abnormal and triponin levels were up at 1680. An angiogram was done which showed a LAD occlusion. An echo was done showing significant left ventricular systolic dysfunction with an ejection fraction of 30% and mild valvular regurgitation (mitral) as well as small pericardial effusion. The doctor regarded it as late presentation and immediate intervention to the LAD was now considered inappropriate. NM REST MYOCARDIAL PERFUSION and MRI CHEST Was done.
    Examination: NM REST MYOCARDIAL PERFUSION
    Date of exam: 26/01/2016
    Addendum:
    The small area with significant viable myocardium in the distal septum involves less than 5% of the LV myocardium.
    -Addendum end———————————————–CLINICAL INFORMATION: LAD infarct.

    TECHNIQUE:

    1113 MBq of 99mTc – Tetrofosmin were injected at rest and a gated SPECT study acquired one hour later.

    FINDINGS:

    The left ventricle is enlarged.

    The perfusion study reveals a large area of infarction in the apex and the anteroseptal wall.

    A small area of viability is seen in the distal septal wall within the area of the infarct.

    COMMENTS:

    Large infarct in the apex and the anteroseptal wall with a small area of viability within it in the distal septal wall.

    RADIOLOGY DEPARTMENT
    Examination: MRI CHEST
    Date of exam: 27/01/2016

    Cardiac MRI: Function and Viability
    Clinical information a 48-year-old male patient with acute coronary syndrome. Occlusion of the LAD
    Comparison
    Findings
    Left ventricular measurements
    End Diastolic Diameter: 56 mm (normal, 36-56 mm
    Ejection Fraction: 40 % (normal: male = 56-78%; female = 56-78%
    Stroke Volume: 53 mL
    End Diastolic Volume: 131 mL (normal: male = 77-195 mL; female = 52-141 mL)
    End Systolic Volume: 79 mL (normal: male = 19-72 mL; female = 13-51 mL)
    Cardiac output: 4.4 L/min (normal: male = 2.82-8.82 L/min; female = 2.7-6.0 l/min)
    Left ventricle regional wall motion
    Akinesia of the anteroseptal wall extending to the apex is seen.
    Left ventricle myocardial enhancement
    Delayed enhancement is seen in the anteroseptal wall and apex with evidence of microvascular obstruction.
    Non-cardiac findings:
    No relevant findings are seen.

    Impression

    Global systolic LV function: Poor
    Global systolic RV function: Normal
    LV viability: Large Myocardial infarction involving the anteroseptal wall and apex with evidence of microvascular obstruction. The patient is unlikely to benefit from revascularisation.

    Do you think opening the totally occluded LAD artery would be of much benefit or would leaving him on conservative line of treatment be better. As there is a small area of viable myocardium. Would performing angioplasty to open up the LAD artery be of any benefit as the reports seem to suggest a very small area of viable myocardium in the infarcted anterior segment. Transmural Infarct more than 50 % of the septum.
    Involving 20 % of the left ventricle anterior myocardial Wall.

    Reply
    Dr. Mustafa Ahmed says
    February 29, 2016 at 2:20 am
    In the situation described, medical treatment would be typically advised over any type of intervention.

    Reply
    Iyman sherman says
    February 29, 2016 at 6:25 am
    Many thanks Jazakallahu kheir for your answer however kindly advise
    1. which medication will he have to use for life time- taking in mind he is only 48 years old.
    2. Can he lead a normal lifestyle other than watching his diet and being physically active with exercises.
    3. Are his chances of a recurrence of an MI higher than any other individual
    4. At what level should we work at getting his ejection fraction be?
    5. What preventive measures should be taken?

    Reply

    • Type out your question here if you are comfortable and i advise you keep personal identifying information private.

      Reply

      • Dear Dr I have paraxysmal atrial afbrillation. it occurs once a week lasts for 3 hrs., recently lasted 2 days. Sometimes manage symptoms at home other times I go to ER I have mild dilation of heart and mild mitral,atrial and pulmonary regurgitation. Recent CTA scan showed less than 25% narrowing of LAD a single calcification plaque. I exprience severe fatigue not sure what causes that. I also have Hashmotors disease. I am 64years old. How would you personally treat a patient like me.

        Reply

        • I would make sure the thyroid disease is well controlled and send you to an electrophysiologist.

          you can follow our twitter at @MustafaAhmedMD

          Reply

      • My husband had a stent fitted 1 month ago and was also diagnosed with mild LAD disease. His job requires a lot i heavy lifting and is very physical would this pose a problem with the mild LAD. Many thanks Sharon

        Reply

        • This needs to be answered by the treating physician with regards to post stent activity. The mild LAD disease is unlikely to be related to any decision making.

          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.

          Reply

    • What does the following statement mean? LAD has subtotal occlusion in the mid segment with a TIMI -1 0 flow and 99% stenosis.

      Reply

      • It means that you have minimal flow only in the artery. TIMI 1 is minimal flow, TIMI 3 is normal flow.

        Reply

  11. Dear Dr. Ahmed,

    Greetings! I had an angiogram done recently. The following is the report of Angiogram :

    Left Main : Is normal

    LAD: Is a type III vessel and shows mid plaguing. Large diagonal shows proximal 80% stenosis.

    LCX: Is a co-dominant vessel and normal. Its OM branches are also normal.

    RCA: Is a co-dominant vessel and shows proximal 40% stenosis. PDA and PLB are normal.

    Recommendations by doctor in India : Myocardial revascularization

    Please advise whether I need Angioplasty and Stent for LAD diagonal ? I am not having any angina or chest pain. I just have some headache on the back side of my head if I brisk walk for more than 30 minutes continuously. I have a history of hypertension for last 15 years.

    Thanks

    Vinay

    Reply

    • Hi, To advise you accurately i would have to see the angiogram. Essentially it depends on the characteristics of the lesion which would dictate the the suitability for stenting. Also why was the angiogram done in the first place?

      Reply

  12. Dear Dr. Ahmed,

    Thanks for your reply. Really appreciate.

    Angiogram was done as my TMT was positive for reversible ischaemia. I have had 3 TMTs so far and all of them were positive for reversible ischaemia. I can try to send you the copy of the angiogram if you share the email id.

    Thanks again.

    Regards
    Vinay

    Reply

  13. My doctor recommended the following INTERVENTIONAL ATTEMPT: Strongly recommended to patient to consider CABG with LIMA to LAD, SVG to first diagonal, and SVG to OM 2. The first diagonal branch is 100% blocked while there are collaterals from the RCA that fill up to the second diagonal vessel. I only feel exhausted when walking hills and up slopes. Can I get by medications only. Jazak allah Khairan

    Reply

    • It honestly difficult to say without seeing the films and knowing more details of the history, and the heart function etc.

      Reply

  14. I have written to you before above on my husband’s medical condition. He had an MI on 23rd January and it was a late presentation as we went to hospital on 25th January so after an angiogram and various viability studies NM REST MYOCARDIAL PERFUSION and MRI CHEST- the doctor opted for medical treatment so no angioplasty or stenting was done. He was put on medication including plavix. 6 weeks later on 29 February the cardiologist repeated the echogram and replaced plavix with xarelto 15mg bd for 3 weeks and from 19 March 20mg od for 3 months after which he will do an MRI of the chest to decide whether he will put him on warfarin or continue with xarelto. What would be the deciding factor?

    Reply

    • Im guessing that your husband has been placed on the Xarelto for either very poor heart function or the presence of a clot in the heart. The MRI will likely be to see if the clot has resolved or not and if the blood thinner can be stopped. I’m only speculating though without knowing details of the cho.

      Reply

  15. The xarelto is due to the clot On th L AD which was there since the MI on 23rd Jan but we were initially put on plavix and a month later on xarelto . Why were we not put on xarelto immediately. and if in two more months it doesn’t work he may have to be put on warfarin to dissolve the clot. Have read on warfarin and it’s not the best of drugs for a 48 year old. what options other than warfarin do we have. Are these medications doing the same job as an angioplasty but through medication

    Reply

    • I doubt the clot would be on the LAD to lead to treatment with xarelto/warfarin do you have details of the original report.

      Reply

  16. Yes I do have reports

    we went to hospital he did an ECG which was abnormal and triponin levels were up at 1680. An angiogram was done which showed a LAD total occlusion. An echo was done showing significant left ventricular systolic dysfunction with an ejection fraction of 30% and mild valvular regurgitation (mitral) as well as small pericardial effusion. The doctor regarded it as late presentation and immediate intervention to the LAD was now considered inappropriate. NM REST MYOCARDIAL PERFUSION and MRI CHEST Was done.
    Examination: NM REST MYOCARDIAL PERFUSION
    Date of exam: 26/01/2016
    Addendum:
    The small area with significant viable myocardium in the distal septum involves less than 5% of the LV myocardium.
    -Addendum end———————————————–CLINICAL INFORMATION: LAD infarct.

    TECHNIQUE:

    1113 MBq of 99mTc – Tetrofosmin were injected at rest and a gated SPECT study acquired one hour later.

    FINDINGS:

    The left ventricle is enlarged.

    The perfusion study reveals a large area of infarction in the apex and the anteroseptal wall.

    A small area of viability is seen in the distal septal wall within the area of the infarct.

    COMMENTS:

    Large infarct in the apex and the anteroseptal wall with a small area of viability within it in the distal septal wall.

    RADIOLOGY DEPARTMENT
    Examination: MRI CHEST
    Date of exam: 27/01/2016

    Cardiac MRI: Function and Viability
    Clinical information a 48-year-old male patient with acute coronary syndrome. Occlusion of the LAD
    Comparison
    Findings
    Left ventricular measurements
    End Diastolic Diameter: 56 mm (normal, 36-56 mm
    Ejection Fraction: 40 % (normal: male = 56-78%; female = 56-78%
    Stroke Volume: 53 mL
    End Diastolic Volume: 131 mL (normal: male = 77-195 mL; female = 52-141 mL)
    End Systolic Volume: 79 mL (normal: male = 19-72 mL; female = 13-51 mL)
    Cardiac output: 4.4 L/min (normal: male = 2.82-8.82 L/min; female = 2.7-6.0 l/min)
    Left ventricle regional wall motion
    Akinesia of the anteroseptal wall extending to the apex is seen.
    Left ventricle myocardial enhancement
    Delayed enhancement is seen in the anteroseptal wall and apex with evidence of microvascular obstruction.
    Non-cardiac findings:
    No relevant findings are seen.

    Impression

    Global systolic LV function: Poor
    Global systolic RV function: Normal
    LV viability: Large Myocardial infarction involving the anteroseptal wall and apex with evidence of microvascular obstruction. The patient is unlikely to benefit from revascularisation.

    Do you think opening the totally occluded LAD artery would be of much benefit or would leaving him on conservative line of treatment be better. As there is a small area of viable myocardium. Would performing angioplasty to open up the LAD artery be of any benefit as the reports seem to suggest a very small area of viable myocardium in the infarcted anterior segment. Transmural Infarct more than 50 % of the septum.
    Involving 20 % of the left ventricle anterior myocardial Wall.

    The xarelto is due to the clot On th L AD which was there since the MI on 23rd Jan but we were initially put on plavix and a month later on xarelto . Why were we not put on xarelto immediately. and if in two more months it doesn’t work he may have to be put on warfarin to dissolve the clot. Have read on warfarin and it’s not the best of drugs for a 48 year old. what options other than warfarin do we have. Are these medications doing the same job as an angioplasty whilst I have accepted angioplasty is not an option but through medication. I can send the actual medical reports if you sent me an email address. He is on xarelto od, Aldatone od, bisiprolol od, ramipril od ivabradine od, Lipitor od, aspirin od and Lipitor od. Pandocid od. We are to do an MRI of the chest to decide whether xarelto did the job or we have to go to warfarin and I have a lot of reswrvations for warfarin. Why are we on xarelto and not plavix like the first month of treatment? What is the deterring factor as to whether we will move to warfarin? If the clot is there and we have to live with it why do we need warfarin? If you need the echo results and all other results I can send them to you via email if you give me your address. My husband had the MI four moths ago but he i.e. Overwhelmed by fatigue and religiously watches his diet and walk 30 minutes on the treadmill. I need guidance please help me we are a young couple with 15/14/10 year old children and can afford any best treatment available. It’s just lack of knowledge that puts me at the mercy of others. Jazakallahu kheir

    Reply

  17. Hi there..

    My mother had an Agiography done recently. The result was normal, however, it is mentioned that LAD D1: There is 90% ostial stenosis.

    Can you please explain whether this needs any urgent review or examination.

    My mother is 64 yrs old. No stent or Bypass performed. Has a minor attack earlier (when not known) that was not detected until ECG and EECO test performed.

    Please advise.
    Shreedhar

    Reply

  18. Im 57, do 4 miles on treadmill everyday, My cardio doesn’t seem to worried, is this reasonable?

    STRESS EXAM DESCRIPTION:
    Stress echocardiogram was performed using the Bruce Protocol. The patient exercised for 11 min and 24 sec, to stage IV of the exercise protocol, achieving 12.8 mets. The peak heart rate achieved was 148 bpm, which was 91 % of the age predicted max heart
    rate. The peak blood pressure during stress was 189/68 mmHg. The double product achieved was 27972.

    BASELINE:
    The patient’s baseline blood pressure was normal. The resting blood pressure was 100/65 mmHg. The resting heart rate was 70 beats per minute. The baseline rhythm was normal sinus rhythm. There were no arrhythmias. ST segments or T waves were normal at
    baseline. Anterior ECG leads at baseline demonstrated poor and/or no R wave progression.

    ADDITIONAL BASELINE FINDINGS:
    LEFT VENTRICLE: Global left ventricular systolic function is normal (LVEF 60-65%). Left ventricular segmental wall motion is normal.

    STRESS:
    The patient experienced palpitations. The primary reason for test termination was fatigue. The blood pressure response to stress was normal. The heart rhythm during stress was sinus tachycardia. There were no arrhythmias.
    Inferolateral ECG leads with stress demonstrated minimal (12 bpm). Blood pressure returned to baseline within 3 to
    5 minutes.

    SUMMARY:
    1. Abnormal exercise stress echocardiogram at an adequate cardiac workload demonstrating a small LAD territory infarct without obvious ischemia.
    2. Good exercise tolerance.
    3. Blood pressure response to stress was normal.
    4. Patient’s symptoms were not suggestive of ischemia.
    5. ECG findings are not suggestive of ischemia.
    6. No exercise induced arrhythmias were noted.

    Reply

      • Heres the rest….

        Procedure Performed: Echo stress 2D w/wo M-mode (93350-26); ECG stress test,
        physician supervision only, w/o stress echo (98016).
        Other Study Information: Not intubated, no pacemaker or central lines.
        Stress Data:
        Peak HR: 148 bpm
        % of Target 91 %

        STRESS EXAM DESCRIPTION:
        Stress echocardiogram was performed using the Bruce Protocol. The patient exercised for 11 min and 24 sec, to stage IV of the exercise protocol, achieving 12.8 mets. The peak heart rate achieved was 148 bpm, which was 91 % of the age predicted max heart
        rate. The peak blood pressure during stress was 189/68 mmHg. The double product achieved was 27972.

        Reply

        • Ideally there would be a detailed analysis of your wall motion on the echo during the stress portion.

          Reply

          • here is this….

            Global left ventricular function increased appropriately with stress. No new segmental wall motion abnormalities were seen. Global left ventricular systolic function at peak stress is normal (LVEF 70-75%).

            LV WALL SCORING:
            Baseline The mid and apical anterior septum and apical anterior segment are
            hypokinetic. All remaining scored segments are normal.
            Peak The mid anteroseptal segment is hypokinetic. All remaining scored
            segments are normal. Not all LV segments were well visualized.
            Recovery The mid and apical anterior septum and apical anterior segment are
            hypokinetic. All remaining scored segments are normal.

          • It looks like there are no new abnormalities on the stress portion of the echo which may mean no further treatment other than current is required.

          • My LAD has multiple stents with some inside others and one occasion clotted and caused an MI which was removed/ dissolved . Last week I was rushed to ER and had 3 stents to mid LAD and 2 days later blocked. My cardiologist says nothing to do as that 20% of heart has died no point reopening the LAD. He also says bypass not viable. I am now worried as still getting angina. Is he right or should I seek 2nd opinion.

          • If there is no viable tissue then stenting is not likely to be of benefit unless there is truly persistent pain despite optimal medical treatment of angina. If you would feel more comfortable with a 2nd opinion I’m sure the initial physician won’t mind.

  19. I had two LAD heart attacks last year Aug 2015. I have 4 stents and ICD implanted on Sep 30, 2015. My EF 29% at that time. I am on heavy medication. Since then, participated/completed Rehab, watching for my diet, less than 1800mg salt per day. I had my MUGA test in Jan 2016 and EF was up to 40%. Regular workout. I am 49 years.

    Please advise how do I manage this in future to avoid another heart attack. How regularly I should have my heart tests. Would my EF be normal in future?
    Thanks,
    Amir

    Reply

    • Best thing is to be compliant with medical regimen, pay attention to risk factors, lifestyle and symptoms, regular follow up, and keep active.

      Reply

  20. I have had multiple stents to LAD, many inside others, once clotting a day after causing an mi. Last week I had 3 more stents in the LAD during which it was ruptured and scented also. 2 days later it has totally blocked again. My cardio specialist says he will not stent any more and leave the mid LAD blocked as 20% heart has died. Also says bypass would not be viable. I am already on multiple medications but still getting angina. Now home and worried.

    Reply

    • hey Peter. I also have multiple stents in LAD, placed in March 2017. Worry about them all the time. Just checking in to see how you are doing..

      Reply

  21. I have had my bypass surgery done 7 weeks ago with no complication other than incision recovery, is fasting ok now or not?

    Reply

    • You should be able to do pretty much as you please in terms of diet this far after the surgery, although your medication timing would need adjustment

      Reply

  22. I have 90% blockage of left main and am scheduled for stent next week. I had 90% blockage and bypass surgery in same location 15(?) years ago and am worried. I understand stents have improved greatly but I was wondering what I can expect.All of the men on my dad’s side of the family died of heart disease in their early 60’s but were untreated and heavy smokers. I am 62 and quit smoking 10 years ago.

    Reply

  24. Hi, I had 70% blockage in the LAD 6 years ago…. I had been having a very high resting heart rate but my Bp was overly high…….
    I had been having problems with 2 large varicose veins, one in each leg…. It’s miserable…. My cardiologist did a Venus Doppler US, and I have Venous reflux in both legs. The vein goes from my feet up into my belly area. I’m going Monday to have a test to see if there is any blockage in my belly area before they do anything to see if there is an underlying problem…….
    I have been having heavy heart palpitations and have been checking my Resting heart rate and its staying around 99- 109……. Could this be from my legs???? I stay so lethargic….
    Can you help give me insight to this? I feel as tho I’m going crazy…… Thank you….

    Reply

  25. Is 99 to 109 a sign that something is definitely wrong? I can feel my heart racing all the time……

    Reply

  26. Hi.my father had 1spent in lad about 4 years ago. After that he did stress test and echo and it was always good. 1 month ago he went for checkup and Dr said stress test has a very little problem then he did thallium test and Dr said his main artery I think lad is blocked moderate. He suggested angiography. But my father says I have no symptom, no short breath no pain even in exercise. What should we do? My father fear from angiography. And Dr increased his nitrocardin to 6.3 tree a day. Sorry my English is too bad

    Reply

  27. My father is 63 yrs old … He is diabetic since 20 yrs on insulin since 3 years….now he has 3 vessel coronary artery disease…angiogram done ….its findings are…LAD mid 90% distal 70% diagonal osteal 70-80% , LCX MID 100%, RCA prox 95%, mid 80-90%….one dr advosed him cabg nd cardiology interventionist saying stents can be placed 3 stents in LAD nd RCA…nd will leave lcx as it is blocked….kindly tell me which is the better option cabg or angioplasty? As my father is little bit reluctant for cabg….nd tell me this too that leaving lcx blocked is dangerous or not?

    Reply

  28. Non smoker ,non drinker , reasonably physically fit, 51 yrs next month ,was asked by office doctor to CT coronary angiogram as a part of annual health checkup .
    Total cholesterol 196 , LDL 128, HDL ,50 , triglycerides 108
    Conclusions :
    the coronary calcium score is 33.5 . This is above 50th percentile for age and sex.
    A focal 75-80% narrowing in the proximal LAD with fibrocalcific plaque. Type III LAD,extending beyond ventricular apex. It is normal in course . There is fibrocalcific plaque noted in the proximal LAD approx 0.7 cm beyond origin causing significantly focal 75-80% narrowing .the involved segment measures approx 0.8 cm in length . Rest of the LAD appears unremarkable.D1 and D2 artery noted , appears unremarkable.

    I was then asked to do thallium stress test :
    Exercise duration : 11.10 min
    % THR achieved : 91%
    Double product 29450
    ECG changes : up sloping in V4-V6
    Effort tolerance : good

    Impression
    Myocardial perfusion imaging is abnormal
    Normal resting LVEF noted
    Small area of inducible ischemia is noted in the basal infero septum and mid and basal inferior wall
    No evidence of inducible ischemia anywhere else in the myocardium
    Low risk scan for future cardiac events

    Doctor , totally confused now .

    Reply

    • You have blockages but they aren’t critical, according to the tests the overall general risk is too low to justify invasive testing unless your symptoms were to progress or not be settled by medicines, at this point optimization of medicines, control of risk factors etc is advised in general.

      Reply

  29. I just found out i have a 60% and a 70% blockage in my lad area. I experience pain and shortness of breath. My cardiologist decided to use meds to treat but at first was going to use stent. Anyway im afaird due to my family history. The meds are making me sick what should i do?

    Reply

  30. Hi Doctor,

    I did a CT Coronary on the recommendation of the General Practitioner (no symptoms, but am Type II diabetic for about 18yrs HbA1C 6.9). That showed 90%block in proximal LAD and 50% in distal RCA). Calcium score 0. Was recommended to see a Cardiologist.

    The Cardiologist got me do the Treadmill stress test – achieved 118% of target heart rate, HR 164/94, and perfectly normal ECG.

    ECHO report – All 1, mild mitral and tricuspid regurgitation, all normal (LA, RA, LV, RV) except 30 mm PASP.

    Is it recommended to do a Angiogram and stent?
    Can it be treated with medicines?

    49 yrs/ family history of diabetes, high BP but no cardio disease).

    Reply

    • It depends on the lesion and the images. I would recommend some form of imaging stress test such as nuclear stress test or stress echo to evaluate the functional significance of what appears to be a relatively stable lesion.

      Reply

  31. Wonderful site with very useful information. Thanks for that. I had a routine stress test as part of annual physical on Monday this week. Results sent me for Cath of heart same day. 80% blockage of the LAD identified. I’m waiting for consultation, but the Dr. performing the Cath. said that as a result of “location” open heart surgery would probably be the proposed treatment. My question: When is angioplasty not an alternative for an 80% blocked LAD? No other symptoms.

    Reply

    • Im guessing its at the very beginning of the vessel. I would have to see your films to comment further. I don’t feel that this is necessarily a contraindication to angioplasty and stenting unless the other vessels are felt to be at risk from this. Particularly if there is only single vessel disease.

      Reply

  32. Last July I went to the emergency room with chest pain and nausea. Ultimately, a catheterization was performed indicating an 80% blockage of the LAD. Open heart surgery was performed with a single bypass. A couple of weeks ago back in the same hospital with another catheterization due to chest pain. This time told by a different cardiologist that the bypass collapsed and the blood was flowing through the native artery (no blockage). How does this happen?!

    Reply

    • It happens typically when the blood flow was too good in the native artery and a bypass wasn’t required. The native flow, if ok, will always win and the bypass will fail. This is why bypass is reserved for critical blockages. Use of tests such as FFR and IVUS can prevent this from occuring.

      Reply

  33. My mother 52 years old. sufferers from unstable angina for 5days EST positive at stage 2 about 3 months back cardiac catheterization shows minor plaque disease in mid LAD, D1 proximal vessel, proximal 80%stenosis, non dominant Osteal minor disease. She was a hypertensive pt and was hyperlipidaemic at the moment. She was given medication aspirin, amlodipin and atorvastatin and now the cholesterol levels have gone down. My question is when there is 80% stenosis should not we do a surgical approach? Can only medical treatment reverse this blockage? Is she in a critical condition? She is still very active and has not suffered from any chest pain for 3 before this.

    Reply

    • She has a blockage in a second order branch not a first order branch and in general this is not critical. Medical therapy would be advised in most cases and intervention such as a stent only done if that doesn’t work. The treatment in either case is mainly for symptomatic relief. Surgery in general is not recommended for that.

      Reply

  34. I am 57 y/o, happily married, petite female (111# – 113#, 5-5″), non-smoker, non-drinker, easy going personality, model/worship leader, recording vocalist. I have a active lifestyle walking/fitness, eat healthy, daily herbal vitamins, flax seed & other natural supplements. My CT cardiac score in April 2012 was LAD-19 & I had the same score Nov 7 2016 w/ other findings; mild artherosclerotic plaque burden, mild or minimal coronary stenosis likely, implications for CV risk moderate. My lipid panel increased Cholest-241, HDL-100, LDL-127, Non-HDL-Chol-141. My BP usually runs low averages; 116/60. Even though I am not overweight and have active live style, I am concerned with the score at my age. Family Hx: my father had a heart attack in his early 50’s triple bypass, VAD, eventually a heart transplant. We were blessed to have him with us until he died last year age 77. My mom & my brother have HBP. Is there any GENETIC HEREDITARY correlation for my CA score abnormality and possible heart concerns? I would rather not be on medications. Do you have any recommendations with natural ways to reduce the plaque. I took refined Fish Oil faithfully but experienced some reflux, so I stopped taking it last year. I would like to research what type of Fish Oil that will not give reflux symptoms, and begin taking it once again. I look forward to your response. Thank you for taking time to help provide me some advice. God Bless You.

    Reply

    • You appear to be in good shape with a good lifestyle. Your tests appear to be reassuring. When it comes to natural treatments, there are many theories however no real evidence exists. While i don’t endorse a particular treatment, i don’t think we should be entirely dismissive of them. Im not familiar enough with the topic to intelligently advise you.

      Reply

  35. DR.Ahmed,
    Please suggest as per below angiography DVCAD results,what will be the best for my mother 60 year old diebities patient.
    1.LMS NORMAL
    2.LAD 40 to 50% disease in proximal course
    3.LCX NORMAL
    4.RCA Critical disease in proximal course
    5.LV Angio GOOD LV FUNCTION

    Waiting for your kind suggestion
    Thanks

    Reply

  36. Hi,

    My Father’s age is 66 years old, physic is week and a diabetic patient. He had minor heart attack two weeks back. So we visited Cardiac Specialist and did Aangiographi and found below details.

    Left Main : Normal

    LAD : Mid LAD 80%, Distal LAD 75%, and Diagonal mid 80%

    LCX : Mid LCX 85%, PDA 50%

    RCA : Small and non dominant, Mid RCA 85%

    Both Renal arteries are normal.

    Dr advised us to do Plast for LCX which is 85%. Can you please advise your view.

    Reply

    • I will only give you broad advice, i cant comment specifically without knowing the full case details. Most of the time, with the findings shown in the angiogram, bypass surgery would be considered, particularly in a diabetic with multi vessel disease, however that depends on other factors also. I would need to see the films to comment on the findings.

      Reply

  37. I am 45 yrs old male. My BP was 140/90 for the last 5 years. I generally looked exhausted and felt breathlessness on climbing/high altitudes. I suffered heart attack in June,2015 and was wrongly diagnosed for gastric problem. After 1 week I underwent Troponin test which was positive. Angiography was done which showed 95% LAD (ostial) blockage and 40% RCA blockage. I underwent Angioplasty and DES (35 mm XENICE stent) was implanted in LAD. After 6 months, in Feb 2016 I felt breathlessness and feeling of passing out. Angiography showed instent restenosis and 90% blocakage in RCA.Doctor advised for CABG or two more stents. I opted for stents. One was placed inside the blocked stent in LAD and another was placed in RCA. After 1 month I had feeling of passing out/breathlessness and Angiography was done. Both stents were patent but the revascularization of LAD had resulted in decreased flow in the Diagonal Artery.
    Now 9 months have passed since the second Angioplasty. During this period I have stuck to healthy healthy diet, Prescribed medicine and regular exercise. EF during the period remained 55%. From last 15 days I feel breathlessness while climbing stairs.
    Please advise me about my current status of my heart health and on future course of treatment in case re stenosis occurs again.

    Reply

    • You need a cardiac stress test to assess for patency of the current stents and potential other blockage. I suspect surgery is the best course of action if your problems recur.

      Reply

  39. My other reports are:

    Homocysteine 13.20 umol/L ( Range 5.46 – 16.20)
    Lipoprotien (a) Lp (a) 60.50 mg/dl ( Range < 30)

    Reply

  40. Hello 5 days before my father got an heart attack and doctors called it NSTEMI attack
    They suggest me angiography and I convinced and they done it ..after that they told me that .He have serious blockage in LAD ATTERY 80_90% blockage and also a blockage in CRA Up to 99% know they suggest me to do angioplasty (stents) what should we do know ???

    Reply

    • The treatment options are stenting vs. bypass surgery, i would need to see the images and understand more about the case before giving you a responsible opinion. Ask your dr to explain the benefits and risks of BOTH treatments.

      Reply

  41. Hi,2months ago my father did angiography and shows 95% blockage in LAD and doctors thought the case is for stents and he did that day imidiately 3stents but after that now he is having problem with breathing “shortness of breath”, he did the echo everything looks good, the EF=56..now i think he has some deppresive simptoms and not sure is this coming from the heart problem or neurologic problem and this is taking to long..what do you suggest, what should we do?

    Reply

  42. My father was 70 years old ,he passed away ,This was his angiograph report.
    I really dont understand what happened as Doctor says though they were complete blocks he would survive .He has shortness of breath for hours and then he passed away .they were unable to perform an angioplast as they said the blocks were too thick .hes had a bypass earlier .
    Angiogram : left main : diseased native tvd
    lad : faint outline of lad is seen .
    lcx : faint outline is visible .
    rca : dominant vessel .
    blocked 100 % at proximal segment after the RV Branch .
    pda and plv are faintly visualized retrogradely by collaterals .
    svg grafy=t to lcx/omi is blocked at aortic end 100 %
    lima to lad is patent .

    impression : native tvd
    rca 100% (proximal )
    blocked svg to lcx
    patent lima to lad
    advice : ptca + dec to rca

    Reply

  43. Last week Thursday (1/5/17) I had a stent placed in my LAD making it my 8th stent in 6 years, this is the sad part of the story the day after Christmas I suffered with the worst chest pains I have ever experienced in the 6 years so I had a family member take me to Memorial Hospital In Pembroke Pines Florida so according to protocol they have to keep me for 23 hours so at discharge I was still having chest pains and shortness of breath and my trop level was .175. Two days later same deal went back to the er this time they kept me for 9 hours and again Memorial Regional In Pembroke Pines Florida discharged me with chest pain and high trop levels, now this brings me to 1/3/17 so same deal the only difference I went to a different Memorial hospital (west) after they started taking blood every 4 hours and noticed my trop level kept raising ( RED FLAG) so needless to say I was scheduled for a cat the next morning, after the procedure the doctor showed me the before and after pictures , I am amazed that I am alive today Thanks to DR Ibrahim. any feedback is appreciated.

    Reply

  44. My brother passed away on December 5, 2016 at the ago of 40. He was the “picture of health” always very healthy, very active, never over weight etc. He went to work that Monday morning like normal, worked all morning then him & his crew went to lunch as normal, they all got back from lunch that afternoon & my brother had asked one of the other guys if his stomach was upset since eating bc he told the guy he was extremely sick at his stomach very hard cramps then turned to walk to truck & collapsed. His coworkers immediately started CPR but there was never a pulse recovered from the moment he hit the ground. We got the autopsy results back last week & cause of death was atheroslecoric coronary artery disease. He had a 90% blockage in the LAD & 75% of aortic stenosis. Which I’m assuming was the widowmaker heart attack. This has completely devastated our family as he leaves behind our parents, a young wife of only 35 & two young children ages 10 & 13….he also was my only brother. There were absolutely no signs or warnings present before this happened. This article has been so helpful in the understanding of what happened to my sweet brother. It’s also nice to read all the comments of others who have experienced having this heart attack & to know others have lost young loved ones to the same thing as I have makes it a little easier to cope knowing that others have been through this tragedy as well makes you feel so not alone in this horrific situation.

    Reply

  45. My father had 70-80% /12mm blockage in LAD in sep ,16 and doctor suggested him heart surgery but he refuse to do that and started some ayurvedic treatment with english medicine. With this he change his routine to a healthy routine. As he is a force person he don’t get much time for doing everything on same time daily but now he decided and doing this till now. Now again he have done engeography and his report shows 60-65% /12mm blockage in LAD. And he wants to continue his routine and medicines for rescue this problem.

    May I know what you suggest for the same?

    Thank you.

    Reply

  46. I bad a CT scan Of The Heart done in november because of Family Nostrom. 1. Calcium score of 337.73 . 2. Severe proximal mid left anterior descenting arterie atherosclerosis with potentially obstructive stenosis At The ostium Of The left anterior discenting artery And At the early mid portion with potential short segment chronic total occlusion . 3. Moderate nonobstructive atherosclerosis Of The mid portion Of The left circumflex artery .4. Normal left ventricolar systolic function . A nuclear stress test fellowed a week later it was normal. One doctor put me on statin , another Dr said i need a angiogram . What Will value your opinion , thank you

    Reply

    • Its an interesting situation and there are two ways looking at it. If you truly have no symptoms at all and you have a totally normal stress test then many would say its reasonable to take a conservative approach and optimize medical therapy. I don’t think it would be wrong however, with such a CT scan to proceed to angiography for the purposes of defining your anatomy given that you initially had chest pain. Was the initial stress test involving a treadmill and if so what was the exercise capacity and level achieved and how was the EKG. If these were stone cold normal then it would strengthen the case for observation and medical therapy.

      Reply

  47. I had a CT scan Of The Heart done in November because of Family history And pressare in My che sta when stress ed. 1. Calcium score of 337.73 . 2. Severe proximal mid left anterior descenting arterie atherosclerosis with potentially obstructive stenosis At The ostium Of The left anterior discenting artery And At the early mid portion with potential short segment chronic total occlusion . 3. Moderate nonobstructive atherosclerosis Of The mid portion Of The left circumflex artery .4. Normal left ventricolar systolic function . A nuclear stress test fellowed a week later it was normal. One doctor put me on statin , another Dr said i need a angiogram . What Will value your opinion , thank you

    Reply

    • Its an interesting situation and there are two ways looking at it. If you truly have no symptoms at all and you have a totally normal stress test then many would say its reasonable to take a conservative approach and optimize medical therapy. I don’t think it would be wrong however, with such a CT scan to proceed to angiography for the purposes of defining your anatomy given that you initially had chest pain. Was the initial stress test involving a treadmill and if so what was the exercise capacity and level achieved and how was the EKG. If these were stone cold normal then it would strengthen the case for observation and medical therapy.

      Reply

  48. 30% blocked LAD 5 years ago- Had chest pains 2 weeks ago and they did a heart cath again and said I am 60% LAD 40% RCA and 30% (can’t remember) I am now on angina meds but still get a few pains every day but nothing like what took me to emergency room 2 weeks ago. I did fail my stress test but heart muscle good no heart attack but my family history of FH and genetic testing reveals A/P markers which means I believe my liver does not filter things out like cholesterol and sugar. I am type 2 diabetic – i take a U500 insulin (5x’s than most people take) I can’t take statins as they hurt my legs. Men in my family in the 70’s died before the age of 35. Women lived into their 60’s but had angioplasty things done but still passed in their 60’s. The new cholesterol shots are said to be great at lowering numbers but may not help with the clogging of arteries. I am on nothing right now waiting to see my Cardio March 7th.
    Wondering what next step is for me – can’t take meds – diet really not a factor due to my family history. Also when I become more blocked is a stent the right way to go with just 1 blocked over 70% and with my diabetes is that a good idea? I have many questions but seems kinda hopeless right now.

    Reply

  49. A month ago I found out I had 100% Blockage of the LAD and had a stent put in. I’m only 35, just went to see my cardiologist and I still have an abnormal EKG, on my left side. :/

    Reply

  50. My father was getting tired very often. Doctor advices for ECHO and EF is 60℅. Then doctor suggested for TMT and he got tired in 3-4 min. The. Doctor suggested for angiogram and output is 75% blockage in LAD.
    Now he is on medication, aspirin clopikind,losar,korandil. Doctor has advised for angioplasty.

    Please advise

    Reply

  51. Hi – I have a 3cm full (calcified) occlusion in my LAD, 47 years old male, very active non smoker, no other signs of artery issues – my collateral’s have developed – so the only symptom was chest pain on significant exertion (e.g. while running up hills). Stress tests (x 2) were both clear. After two years of symptoms I had an Angiogram this week….now I know the source of the pain, I’m left with two choices (I believe).

    1) Try break through in the Angio lab with balloon and wire – use stents, tricky as the occlusion goes right up to the junction with two branches. About 50% chance of success.

    2) Single Mammary bypass.

    Both clinicians present compelling cases.

    I’m unclear on the longevity of the stent option, and procedural risks with such a significant occlusion – any insights / experience welcome.

    Many thanks Rich

    Reply

    • It all depends on the angiogram and the character of the lesions and i would need to see it to comment to be honest. Also very important if you are to take the stent option is the skill level of the operator, they must be comfortable with a CTO approach and success should be 90 and not 50%. LIMA to LAD bypass is well known to be associated with good outcomes. Also, the bypass option often remains after the stent is attempted.

      Reply

  52. Hi !
    With 60% of LAD blocked , the patient ( my mother) have diabetes , what you recommend a Stent or Open Heart surgery ?

    The Doctor who’S going to do the cath recommend us that he will proceed first with and if he can’t put the Stent cause of the obstruction, then he can proceed with the Open Heart procedure ( he says is the safe way to go) .

    We consult with other Cardiologist to look To an second opinion and told us that the Open Heart surgery is better Than the Stent because of the obstruction location in the artery.

    I know is Hard To Tell without seeing the result of the lab test . But with an 60% you think is Hard To place an Stent ?

    Reply

    • In general 60% blockages don’t require stent or surgery. Usually the lesion will need to be 70 – 80% to be treated or a stress test demonstrate a significant impairment of blood supply.

      Reply

  53. Hi i Was diagnosed with a 70% blockage on the mid LAD through a coronary artery scan, also i have a positive stress Test. My cardiologist said me i Need a cateterization, but i refuse because the risk. I dont have any symptoms, i made one hour of excercise Every day without any disconfort. During the stress Test three are no symptoms too. Acording with the report of the stress Test i present a miocardial ischemia, but my physical condition is excelent. Can i handle this condition by changing lifestyle and medications. I really dont want any invasive procedure.

    Thanks

    Reply

  55. Hi.
    I have a total oclusion of the LAD.
    They tried to stent it but was unsuccessful.
    I then had a Lima to Lad bypass done nearly 4 years ago.
    I am starting to feel unwell again.
    No energy. Very breathless after little exertion.
    Angina sometimes.
    I know I had some other blockages but were not needing treating as were not bad.
    I am 60 years old female.
    Don’t drink or smoke and am a vegetarian.
    My father died of a massive sudden heart attack at the age of 45.
    I was told it I’d genetic.

    Reply

    • Have you had some form of stress testing, if not it is likely a good idea to ensure the symptoms are not related to the blood supply of the heart. If you advent seen a specialist i suggest you see one to ensure the correct work up is done.

      (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 )

      Reply

  56. i am 79 yr old male of south Asian decent. I am well controlled diabetic ,hypertension & hyperlipidemia. post long standing epigastric tenderness dyspepsia no shortness of breath.due to negative gastroscopy and diffuse symptoms, no shortness of breath. EKG, sinus, premature arterial complexes was otherwise normal.Pet scan revealed mild ischemia in lateral wall.leading to cardiac angiography.
    Results show Second Diagonal of left coronary (mid size vessel) has 30 t0 50% stenosis, otherwise mild calcification left Main & LAD.No significant finding in Right coronary. No intervention felt needed.

    My question is if their was100% blockage of second Diagonal, how serious is heart attack.Also what is rate of progress of disease.mind you, even though, am insulin dependent diabetic long time, i am very well controlled.

    Reply

    • A lot depends on the distribution of the vessel and the area at risk but in general the diagonal is considered a 2nd order vessel and if medium in size although the heart attack could potentially be significant its unlikely to be large. Would have to see the films to comment accurately.

      Reply

  57. Hello My grandfather is 77 and just had his first heart attack 2 months after a hemicolectomy. Cardiac cath showed severe blockages and the cardiologist didn’t place any stents because he believes a bypass is the best option. He has past medical history of PAD, Aortailliac bypass in the abdomen 20 years ago and copd. He also a 100% blockage in one of his carotid arteries and the other carotid was 90% blocked and a stent was placed 2 years ago. We went in for pre-op for the CABG and the carotid ultrasound revealed a blockage in the stent. His vascular doctor ordered a cat scan which he said showed scar tissue and he wants to perform another balloon procedure before the CABG. My question is do you think it’s safe to undergo A triple CABG with the total blockage in one carotid artery and stent in the other?

    Reply

    • It seems a high risk situation in general, my advice would be that if you are uncomfortable then seek a second opinion given what is at stake. With this level of complexity i don’t feel i can comment safely without knowing full clinical details and the ‘eyeball test’. In terms of the carotid disease it once again depends on the lesion and the complexity and risk of adressing it.

      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

      Reply

  58. Hello Doctor,

    My mother is 62 years old. She had tiredness and short breathe fro past 1 month. We met doctor on last week and her ECHO test was normal. But ECG test was not good. So we are suggested to go for angiogram test. The report says,

    Left main Coronary Artery : Normal
    Left Anterior Descending Artery : Type III vessel. Proximal 80% Stenosis
    Left Circumflex Artery : Non-Dominant. Minimal disease
    Right Coronary Artery : Dominant. Proximal 70% Stenosis

    Impression: Coronary Artery Disease. Double Vessel Disease.

    Plan: PTCA With Drug Eluting Stent To LAD /RCA. [ within 15 days]

    She has no sugar or pressure complaints, Had Knee replacement surgery on last year. Please do share you suggestions doctor. How serious is this? Is it hard / easy to place the stent?

    Reply

    • Its difficult to answer accurately regarding the difficulty of the procedure without seeing the films. This is a case of symptomatic 2 vessel disease and intervention would appear reasonable. On the information provided, there do not appear to be any strong indications for open surgical intervention and stent placement may be appropriate. You should discuss the complexity and risk of the procedure with the performing physician. In the majority of cases, the procedure should be relatively low risk in the absence of obvious complicating factors.

      Reply

  59. Hello, my father 67 years old before 2 months has complained with shorting of breath, he admitted to hoapital and get medical theray than doctor has requested angiogram, he said all cronary was patent except the proximal LAD aretry has 90% stenosis, doctor said thers is s shape of the LCA its hard to pass it tobrwach the LAD aretry , he did CABG for threee aretry bypass since 11 years ago, he doesnt has any symptoms, doctor said redo CABG is best for him but very high risk, so medical treatment is best for him, his EF 35 % and mild to moderate dilated left atrium and mild dilated left ventricle with moderate regurgitation mitral and very weak stenosis of aortic valve and diabetic and hypertension hyperlipidemia, what bestway to treat this case

    Reply

  60. Hello, I did my angioplasty in Jun 2014 and it was triple vessel disease with 5 stents inserted.
    Out of 5 stent , 1 was bio-absorb-able. Currently after 3 years is there were no symptoms. What is the chance for the re narrowing at the same area with the bio absorbable stent.

    Reply

    • Interestingly the bioabsorbable scaffold will likely disappear within a few years. After that the risk of restenosis is theoretically lower than that if an existing stent were present. In that case the chance of disease progression would depend on the risk profile of the patient and risk factors, and aggressive treatment would serve to decrease that.

      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

      Reply

  61. I am 46 years old male and has smoked for nearly two decades.I had a heart attack on 10 June, 2015 and I had 35mm long stent placed in LAD on 22 June, 2015. Re stenosis occurred within six months and an overlapping stent was placed in LAD on 20 Feb 2016 and an additional stent was placed in RCA.
    Now 15 months have passed since revascularization and Iam feeling OK. I have left smoking. I walk 4 Km every day and play badminton on alternate days. The medicine I take includes Clavix AS, Atorva 40 , Telma 40 , Metoprolol XR 25 and Anxit0.5.
    Kindly advise me if I can fast for the month of Ramadan (16 hrs daily).

    Reply

    • You should speak to you cardiologist. In terms of the medications it shouldnt be an issue. Your exercise capacity is good which is reassuring. Although fasting shouldnt be too much of an issue i suggest you speak to your drs as many factors in a persons medical history need to be taken in to account (kidney disease/diabetes etc).

      Reply

  62. 49 yrs old male 90-95% blockage in lad..had a heart attack 20 days before ant.m.i
    Stent placed 10 days before
    But still their is a very mild pain sometimes
    Is it normal?

    Reply

    • Depends on the situation and accompanying disease. You should clarify this with your cardiologist.

      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

      Reply

  63. I HAVE THREE ARETERIES BLOCKED TWO MODERATELY ONE BEING THE LAD ONE MILD.
    WITHE THE LAD BEING THE WAY IT IS BLOCKED SHOULD I GET AN ANGIOGRAM TO DETERMINE THE EXTENT OF WHAT ELSE.

    I HAD AN MRI WITH CONTRACT AND THE RESULTS CAME BACK GOOD THE EJECTION RATE OF ONE ARTERY AS ABOVE PARAMATER 20-60 MINE WAS 63. MY CARDIOLOGISTSAID THE TEST WAS GOOD RESULTS, IT WAS DONE BY A RADIOLOGY DEPT THAT ONLY SPECIALIZE IN THE HEART.
    KINKILY SAHRE YOUR OPINION AS TO WHAT I SHOULD DO. THANK YOU.

    Reply

    • Get evaluated by a cardiologist who can evaluate your symptoms and assess your need for stress testing and suitably medically treat your coronary artery disease.

      Reply

  64. My age is 41 years & done angiogram report shows below results. Doctore precribed medicine Bataloc 25 (2 times),Clopilet A 75,Flavedon MR 35mg (2 times),Nitrolong 2.6mg (2 times) & Recommendation :PTCA with stenting to the LAD. I do not feel angina but after taking medcine feel dizzy sometimes. After review pls kindly advise my mail ID : sajalm031@yahoo.com

    LMCA :Short normal
    LAD: Shows 70%tubular stenosis in the mid LAD
    LCX:Non-dominat.Normal
    RCA:Dominant.Proximal part shows minor disease.Mild segment shows discrete 40%stenosis
    LV: Good LV systolic function with EF:62%(on echocardiogram)

    Reply

    • Why was the angiogram done? Did you have some form of stress testing to evaluate the significance of the blockage?

      Reply

  66. Hello I am a 46 year old male. The past two years I lost 100 lbs mainly because I am scared. I have lived a very stressful, sedintary, unhealthy lifestyle. I believe I had untreated diabetes for 5 years and was roughly 300 lbs for 10 of the 15 years. I smoked marijuana like cigarettes for 20 years. I would drink about 6 beers a day. I had a very stressful job but the pot helped with stress.

    At the crossroads I was able to turn my life around for my only son and mother- I simply did not want to die at a young age. The past three years I battled to get my health back by controlling my diabetes, exercising, and loosing weight. I completely reversed my diabetes and went off metformin until my doctor told me to to go on 40 mg lipitor. The lipitor bumped my sugar up, so I am holding it off with 2 – 500 mg metformin a day. I currently weigh 205 lbs. I have been living as healthy of a lifestyle as possible. No alcohol besides a glass of red wine, no pot, and a Mediterranean low saturated fat and cholesterol diet. The lipitor worked wonders bringing my LDL down to 60. My blood pressure is good, low triglycerides, HDL just came up to 40 but was always in the 30’s.

    On my own I paid for a calcium score test. It was only $100. My doctor said it was very smart I did it because it bumped me into aggressive therapy when taking into account my other factors. The test came out at 165 with 142 in my LAD area and 23 in my CX area. I have mild cheat pain occasionally and did have a stress test which I passed. I recently read the LAD is considered the widow maker.

    MY QUESTION IS THIS: What are my options for finding out how clogged my LAD is? My doctor doesn’t seem willing to give me the dye procedure where they can see whats actually happening in detail. I’m wondering why this is the case. I would have that procedure done in a second to give me piece of mind. Is this an insurance issue where the insurance companies don’t want to pay for it? Isn’t this basically telling me that only a heart attack will get me the next step in medical care? I mean what is it? What would have to happen. I know they say it is invasive but it’s a very safe procedure.

    Believe me, I DO NOT think all doctors are good doctors, or have your best interest at hand. I have had very ignorant, uninformed doctors, but also great ones. Now I’m on medicaid, but thankful for it. This calcium score states that I have more plaque than 90% of men my age. I’ve controlled all factors besides stress.

    Could you give me any advice, doctor, I would appreciate it. My doctor now is just statin, statin, statin. You know its amazing how most doctors don’t even tell you to take coq10. I’m just scared of dropping dead one day. I know the genetics on my fathers side all died of heart deaths but they were old school Italians who ate pork sausage everyday and smoked Pall Mall cigarettes.

    Thank you very much

    Reply

    • Read this article I wrote previously, it answers your question i think, if not let me know. Its not the blockage itself, rather its the physiologic effect of a blockage that is most important.

      https://myheart.net/articles/stent-save-life/

      If you are interested in cutting edge information and therapy for heart disease then follow my twitter at @MustafaAhmedMD

      Reply

  67. Good Afternoon Dr. Ahmed
    I am a 70 year old male ( Australian ) and was wondering if I could get your comment on my CT Calcium Scoring:
    Findings: There is heavy plaque within the left main, D1 and proximal and mid LAD and a relative low volume within the proximal RCA. The calcium score is 810 and volume 694 mm tube. There is aortic root mural calcification though no aortic valve calcification – the aortic root is normal in calibre. Interpretation: Calcium score of 810 at the 81st percentile.
    Total cholesterol is 128mg/dl – HDL is 35mg/dl Systolic BP 138 Diastolic is 69 and Heart Rate 58. Medication: Aspirin 100mg, Twynsta 80/10 and Atorvastatin 40 mg and do 5 x week 40 min moderate aerobic.
    Can the calcification be removed by taking additionally Kyolc and Vit. K2 ?
    Thanks a lot for listening – seems you Guys in the States are a bit ahead of us.
    Regards
    PS: Would it be possible to send a copy of your reply also into my Inbox, thanks.

    Reply

    • Read the following article and see if you still have questions

      https://myheart.net/articles/ct-coronary-artery-calcium-heart-scan-the-facts/

      A lot depends on why the test was performed in the first place. In terms of vitamins to reduce the calcium burden there is no real evidence to guide that and they are not recommended or advised against from a medical perspective. Of course first and foremost attention to risk factors is key. You seem to be on a good medicine regimen. In terms of next best step, stress testing may play a role in determining the significance of the results, particularly if you have symptoms.

      If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD

      Reply

  68. hi, my dad had a heart attack three months ago. his angiogram revealed these:
    LAD: type IV vessel & 90-95% stenosis in its proximal segment.
    RCA: dominant vessel & totally occluded in its proximal segment.
    The doctor’s reccomendation is PCI to LAD and RCA. When we asked about bypass, she said both can be done and asked us to decide.
    Plus my dad has diabetes. he experiences no pain after the heart attack. i am worried. please advice on which treatment will be better. His age is 68.
    Also his AV- cusps are thickened and calcified. AV gradient -23/12mmHg.

    Thank you

    Reply

    • also i forgot to mention, his heart radiological report says that heart is enlarged (C:T = 13 CM :22 CM) in traverse diameter. unfolded aorta is seen.

      Reply

    • With diabetes, totally occluded right and LAD, if the heart is felt to be viable then surgery would typically be recommended with LIMA to LAD grafting.

      If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD

      Reply

  69. Hello Dr. Ahmed,
    2 months ago my dad (68 yrs) had a heart attack. The angiogram was done recently (as doctor’s suggested) and reveals these:
    LAD: type IV vessel & 90-95% stenosis in its proximal segment.
    RCA: Dominant vessel & totally occluded in its proximal segment.

    Echocardiogram: ischaemic heart disease with regional wall motion abnormality present. mild AS with trace AR. mild MR Mild LV systolic dysfunction. LVEF = 45%
    Also, AV cusps are thickened and calcified, heart is enlarged (C:T = 13 CM: 22 CM) in traverse diameter. unfolded aorta is seen.

    He also has type I DM. the doctor recommended PCI to LAD and RCA. but when we asked about bypass she said we can proceed with either and it’s our decision. I’ve been consulting with many patients and other people, plus I’ve read studies done by harvard university and other reliable online sources and papers. they all suggest bypass, especially because of dad’s age and presence of diabetes. I am confused and need your advice.

    Reply

  70. I’m a 63 year old male that just went through an angiogram Doctor said LAD that was stented 2005 is 80% blocked again. He said that I need a bypass. Problem is meet with the surgeon. Who said 75% I would not survive the surgery if I was to survive I would be on a breathing tube the rest of my life. What to do know ?

    Reply

    • Get a second opinion from an experience team that has a heart surgeon and an interventional cardiologist. If the surgery is so high risk that you are turned down it is likely that a stent can be placed.

      Reply

  71. CT angiogram shows that

    Focal eccentric non calcified plaque seen at ostium and the proximal part of LAD with mild luminal narrowing(25-30%). dens eccentric calcified plaque seen in the proximal LAD at he level of origin of first diagonal with blooming artifact and minimal luminal (<25%). Mural thickening also seen in the mid LAD with minimal luminal narrowing. there is myocardial bridging of distal LAD with mild luminal narrowing.

    Please let me know:
    what is this stage?
    Degree of seriousness?
    Solution and way forward to cure this.

    Regards
    Ravindra Rathore

    Reply

    • There is suggestion of coronary artery disease, it is mild in nature as per this scan, it means the process of disease is there however no procedure is needed at this stage. Medical therapy should be started and risk factor management performed.

      If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD

      Reply

  72. Hi I’m 48 year old female, healthy (so I thought) exercise daily eat well not overweight although have smoked for 20 years. I have been getting Angina symptoms went to GP and I had to demand a referral privately to cardiologist. I have 90% blockage low down on LAD and have had a stent fitted, the cardiologist has said that a branch off the LAD is also partially blocked but not enough for a stent. I’m scared and am in shock. Tests showed I have high cholesterol 6.3. My father had 4 way bypass at 41 so I guess its hereditary? My questions are – how quickly could the blockage happen again? I’m scared as to what to eat to try and lower my cholesterol. I’m really depressed and cant shake off that I could have died and don’t know what the future holds for me – Is this an unusual way to feel or normal?

    Reply

    • Firstly your disease is stable and you have been treated for the most serious blockages. Your stopping smoking will do wonders in terms of preventing build up of plaque and progression of disease. You need to be obsessive to risk factors such as lifestyle, exercise, smoking, blood pressure and follow up with your doctor. being scared wont help you. Be positive and have a new outlook and approach to beating the disease, its not at all hopeless!

      If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD

      Reply

    • Bridging is where a section of the artery that is meant to travel over the surface of the heart actually takes a detour deeper in to the heart muscle and so becomes susceptible to being squeezed by the muscle around it compressing it. In some circumstances this can restrict blood flow. In my experience this can almost always be managed by medicines. In rarer cases an operation may be required.

      If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD

      Reply

  74. Please advise how serious this is and what action should be taken. I have been told different things by different doctors.

    1. Left main artery: without flow limiting lesions.
    2. Left anterior descending artery: Diffusely diseased. 80% calcified, diffuse eccentric lesion in the proximal segment after the bifurcation of the first diagonal branch. The LAD is long, wrap-around artery.
    3. Left circumflex artery: 30% stenosis at the ostium. Large caliber, high OM branch without significant angiographic disease.
    4. Right coronary artery: Dominant vessel. 99% subtotal occlusion in the proximal segment with TIMI 1 flow 100% stenosis at the mid segment.
    5. Left ventriculogram: not done due to elevated LVEDP
    6 . Left ventricular end diastolic pressure 40 mm Hg.
    7. 40 mm Hg peak to peak pressure gradient noted on pullback across aortic valve.

    IMPRESSION:
    – Double Vessel Coronary artery disease including proximal LAD and proximal RCA
    – Elevated LVEDP = 40 mm Hg
    – 40 mm Hg peak to peak gradient across the aortic valve

    What would be the correct action to take with these findings? I just want to make sure I go with the right doctor since I have more then one recommendation.

    Reply

    • At first glance it looks like bypass surgery and likely aortic valve replacement. What did the echo show? I would need to see the films to give a more thorough answer.

      If you are interested in information and therapy for heart disease then feel free to follow my twitter at @MustafaAhmedMD

      Reply

  75. My husband underwent a heart cath on September 5, 2017, in order for the heart Dr to get a better look at his heart. My husband had been suffering from chest, jaw and arm burning pain. The dr said all tests came back good, that the pain was blood pressure associated. The dr discovered that his RCA was 99% blocked and ended up placing 64 mm worth of stents throughout the RCA. He has also found 3 blockages in the LAD. The Dr says that my husband LAD is only 2.0 mm so this cannot be stentted, and that even though my husband needs a bypass, his arteries are too small to fix this problem. The blockages are at 80%, 70% and 55%. With this knowledge i was wondering if bypass is a possibility if we seek a new Dr. My husband is only 58 and we still have 2 young children to raise, the outlook that the Dr, gave him wasn’t good, so i am seeking more information. Thank you in advance for your input.

    Reply

    • Its difficult to comment on the LAD without looking at the films, in general if vessels are too small, medical therapy may be preferred to bypass or stenting. If you have questions, its very reasonable to have a surgeon review the films regardless. Outlook isnt dependent on if he can have a procedure or not. Its dependent on many factors such as general health, level of functional capacity, compliance with medications, underlying heart function etc, these are all equally as important in determining prognosis.

      you can follow my twitter at @MustafaAhmedMD

      Reply

  76. Hi, In 2014 I had a heart cath and was told by the cardiologist that I had 50% blockage of the “widow maker” but had 82% blood flow so no stents at that time. Last year he said I needed another heart catheter to check the artery because, “they don’t get better”. I moved and started seeing another cardiologist. I had EKG, nuclear stress test etc., got rescheduled several times and never did get to see the cardiologist again. When my appointment finally came the cardiologist had left and they put me with an Internist/Internal Medicine doctor. He says since my tests don’t show anything a heart catheter is unnecessary. He changed me from simvastatin to lipitor and gave me blood pressure med. Changed me from 325 mg aspirin to 81 mg. My question is should I be concerned, should I make an appointment with another cardiologist. I know nothing about Internist and whether I should trust anyone besides a cardiologist with my heart. My father had several heart attacks and my mother died from a massive heart attack. I don’t smoke but am morbid obese and scheduled for bariatric surgery in January.

    Reply

    • See a cardiologist. I don’t see a good indication for a heart catheterization if you are asymptomatic and have a normal stress test. 81 mg aspirin is likely the correct dose.

      you can follow my twitter at @MustafaAhmedMD

      Reply

  77. I apologize if this is a duplicate but I couldn’t find it in comments so thought maybe it didn’t post.
    In 2014 I had a heart cath and was told by the cardiologist that I had 50% blockage of the “widow maker” but had 82% blood flow so no stents at that time. Last year he said I needed another heart catheter to check the artery because, “they don’t get better”. I moved and started seeing another cardiologist. I had EKG, nuclear stress test etc., got rescheduled several times and never did get to see the cardiologist again. When my appointment finally came the cardiologist had left and they put me with an Internist/Internal Medicine doctor. He says since my tests don’t show anything so a heart catheter is unnecessary. He changed me from simvastatin to lipitor and gave me blood pressure med. Changed me from 325 mg aspirin to 81 mg. My question is should I be concerned, should I make an appointment with another cardiologist. Should I seek another cardiologist for a 2nd opinion? My father had several heart attacks and my mother died from a massive heart attack. I don’t smoke but am morbid obese and scheduled for bariatric surgery in January.

    Reply

  78. My CORONARY ARTERIOGRAPHY results are as mentioned. Left Coronary artery: Left Main stem (Normal bifurcating vessel), Left Anterior descending Artery {(1) there is 60% eccentric mid LAD stenosis, (2) Moderate proximal LAD calcification.}.Left Circumflex Artery : Mid circumflex shows 70% hazy stenosis. Right coronary Artery: Dominant vessel with 60% mid stenosis & 50% bifurcation distal stenosis.
    LV ANGIOGRAM:
    Mild Anterolateral hypokinesia.
    Ejection fraction 60%.
    Conclusion:
    Three vessel coronary Artery disease.
    overall normal LV function.

    Reply

  79. What does this mean: Tight 99% lesion in ostium of diagonal branch, moderate disease in LAD, EF 55%. Also diagnosed with NYHA Class 2 Systolic & Diastolic. I was having chest pain, SOB, and tingling in both legs when walking up hills, that is why I went to a cardiologist. This was back in 2013 and haven’t had any problems since. Everything I have read about LAD is this is a major vessel which feeds a big portion of the heart and if this is blocked will cause majoy damage to ones heart muscle. What are your recommendations on how to proceed with this diagnosis?

    Reply

    • The blockage you had was in a branch of the LAD and not the LAD itself and in stable disease is typically managed with medicines. The moderate disease in the LAD is treated with medicine unless severe, unstable, or symptomatic despite medicines. Seek regular follow up, ensure you have been placed on optimal medical therapy, with lifestyle and risk factor modification.

      you can follow my twitter at @MustafaAhmedMD

      Reply

  80. It was on 8th Jan in the morning, after taking my breakfast , that i started feeling a bit congestion in upper part of the chest. I thought it had something to do with the digestion. A hospital is closed by my residence so I asked my son to take me in the emergency. They carried out an ECG and informed me that there was some irregularity in it and better to consult some cardiologist. Luckily a cardiologist already known to me was in the hospital. Seeing my face, he took no time and dumped me into a wheelchair. I was rushed to the cath lab where they were planning to carry out angioplasty on a patient. In no time i was made to lie on the table and within just few minutes I was feeling absolutely relaxed and normal. I was told by my doctor that had I been a few minutes late, I would have gone. They told me that a clot had occurred which had blocked 95% of my LAD. It was Proximal 95% hazy lesion with TIMI 2 flow. They removed the clot and put a stent 3.0x23mm Xience DES. I didnt get a bloody clue of it what they did and what they said. I later on realized that I was undergoing a heart attack otherwise I was in an impression that I had some digestive problem. By the way, I am a diabetic too but my range fluctuates 8 to 9. Was my condition be called as Widowmaker ? Was it that serious ? Had I survived with just a myo cardiac infraction ? Should I start taking some precautions in diet and the mostttt important that should i keep continuing with my pipe smoking ( I dont inhale the smoke ) ?

    Reply

  81. HI Dr Ahmed,
    My dad (age 61) recently had angiography and is diagnosed with 3 VD.
    His Distal RCA has 70% blockage,
    LAD has blockages at 3 places: 70% proximal, 80% Mid and 70% Distal
    and finally CX has blockages at 2 places 50% proximal CX and 70% mid CX.
    Doctor advised us to go for CABG. At present he does not have any symptoms and nor he had symptoms prior to angiography.

    My question to you is how soon/ urgently he should get this surgery done.
    He is very anxious now since his father passed away with MI at the age of 67 and he is worried.

    Reply

    • The procedure would be urgent if there is evidence of acute coronary syndrome, unstable symptoms or unstable clinical course. This of course needs to be determined by a physician that is familiar with your fathers case.

      you can follow my twitter at @MustafaAhmedMD

      Reply

  82. Hello,

    I am currently working on a cardiovascular modelling (CFD) project. Does anyone know the pressure range in the Left Anterior Descending (LAD) Coronary Artery? I mean the maxmimum and minimum pressure.

    Reply

  83. I am looking for guidance since I have had multiple procedures done on my LAD and it looks like the trend will continue unless I go in a different direction. My background is that at age 32 in 2003 I was told that I had a fray in my LAD and my cardiologist put in 2 stents doubling up in the area affected. In 2013 while on a golf trip I had a massive heart attack in which I was told I lost a third of the capacity of one of my heart chambers. The cardiologist that did the procedure said that there was a gap between the original 2 stents and that they had collapsed. He ballooned the two stents and added a 3rd in the gap. In 2014 I caught my symptoms before I had a heart attack and the 3rd stent which was the newest had failed so my cardiologist added a 4th stent. I now have 4 stents in a very small area in my LAD and annually I start having symptoms and I go in to balloon the stents or at least make sure they are open. I feel like I am a ticking time bomb and there has to be a better solution. Any advice you can give would be great.

    Reply

    • If it happens again discuss with the treating cardiologist whether they feel surgical consultation with LIMA to LAD would be considered.

      you can follow my twitter at @MustafaAhmedMD

      Reply

  84. After having palpitations which lasted for over three hours my Cardiologist ordered a CT Angiogram which showed severe or >70% stenosis in the LAD and a Calcium Score of 6.9. My heart and other arteries were generally normal or with minimal disease. My Cardiologist sent me to the local hospital for stenting,and when they performed an Angiogram it similarly showed 70% diffuse disease in the LAD and minor disease in the RCA. Their conclusion was: ‘Given that patient asymptomatic,and diffuse moderate disease in the LAD continue optimal medical therapy.If convincing symptoms for coronary ischaemia for FFR LAD +/- PCI’.
    And personally recommended to: “Continue with Medical Therapy later consideration for PTCA.”

    I am in Europe at the moment and have presented the CTCA and hospital Angiograms to two Cardiology professionals and after Analysing them they are all reluctant to perform a Stenting procedure on me.My general practitioner here is warning me that something should be done to my diseased Left Ascending artery, even a single stent at the beginning of the vessel, otherwise if it gets completely blocked he says we will be in Big trouble,as they say here?

    I am really worried and have chest pains daily,which I sometimes think maybe Angina,and of which my mother passed away. Otherwise I am 60 years of age and my father,who is now 90 is still going strong and quite healthy for his age.

    Can you please advise me whether it is Necessary or Urgent for me to have Stents in my diffusely diseased LAD as my Cardiologist initially and General Practitioner here advises?

    I thank-You in Advance and give you Christian greetings from Europe!

    C

    Reply

    • The stents are not in general ‘life saving’ unless someone is actively having a heart attack. Your disease being diffuse may mean that the stenting is not simple and a lot of stent may be required something best avoided unless absolutely necessary. The FFR test is another way of checking the severity of a lesion, a negative ffr generally means it can be left alone. In this case i would recommend some form of stress testing to see if the blockages have lead to impaired blood supply that could explain symptoms, regardless, medical therapy here is the most important thing.

      you can follow my twitter at @MustafaAhmedMD

      Reply

  85. Just received the results of my CT Heart Wo Con Coronary Calcium Scoring …
    Total Calcium Score is 639 (Left anterior descending coronary artery score is 576,
    the left circumflex artery score is 21 and the right coronary artery score is 42).
    My QUESTION: how do I calculate the percent blockage in the LAD based on the
    calcium score of “576”. My cardiologist has now scheduled a stress test for me on May 8th.
    Is this a good idea or could kill me? I passed the heart stress test during February 2015.
    Any advice is appreciated!!

    Reply

  86. Hi sir, my mother was facing pain in chest and left arm, so i took her to cardiologists and after examination he told us that LAM has 90% blockage and stent is recommended. So i want to know where is there any other option with us or only stenting is the best treatment for the problem.

    Reply

    • Depends on many factors including anatomy, location, complexity of lesion, patient history and operator.

      you can follow our twitter at @MustafaAhmedMD

      Reply

  87. I had a stent placed in my LAD four days ago. The catheterization showed an 80% blockage. I still feel minor twinges in my chest, along with some acid reflux. Is this normal? I have been avoiding any exertion except moderate walking. I am 72. No history of high blood pressure or abnormal cholesterol and have been very fit most of my life. Not overweight.
    I am on Plavix and Lipitor now. A couple of large purple bruises have appeared on my left arm, on the opposite side of where the catheter was inserted. Is this likely from the Plavix?

    Reply

    • I would recommend being evalauted by the treating cardiologist regarding the chest twinges. The bruises may be related to the plavix.

      you can follow our twitter at @MustafaAhmedMD

      Reply

  88. Hi I have had 4 heart attacks in 19 years 3 stents and on May 10th I went in for chest pains again and that was my 4th and put the 3rd stent also I have Congestive Heart Failure so out of all of this is my first stent is 100% blocked This is in the LAD they just did the stress test and getting ready for results on June 19th is there anything they can do it’s been a long 19+ years Also I am a diabetic Thanks just would like Ideas

    Reply

    • It depends on many factors. If there is a blockage, and the area of the heart supplied is viable, there are options that include medical therapy, further stents or surgery.

      you can follow our twitter at @MustafaAhmedMD

      Reply

  89. Dear Dr Musthafa,

    A relative , 64 year old man, had a stenting this week of his LAD block , which was 70% as per the Cardiologist. It was at the junction of the first and second thirds of the LAD. The cardiac enzymes were done many times. Before surgery the CKMB was raised slightly, (value 25 and normal range upto 17 ). His symptoms , due to which he was referred to the hospital, were an episode of sweating, nausea and dizziness during a flight . This happened twice in the past two years. His symptoms lasted for a few minutes.
    His ECG was fine before and after stenting, and stress test showed a delay in recovery by about 4 to 5 minutes, as the Cardiologist explained to us. The latter result was the reason for going in for a Angiogram in the first place.
    My questions are-
    1. Is stenting preferred or is it better to consider a Bypass ? If so when can it be done? And since stenting is already done, how does this affect a bypass if it is considered?
    2. What are the risks, and how should he take best care of himself?
    3. Is air travel to be avoided? He has to fly long distances once in about 4 to 5 months.

    Reply

    • 1) Depends on the situation, in certain cases stenting preferred and in some bypass, depends on the anatomy and other factors

      2) Risks are a repeat event and depression of disease, care is follow up, medications, lifestyle and prevention

      3) Air travel should be discussed at the follow up appointment and depends on stability of disease.

      you can follow our twitter at @MustafaAhmedMD

      Reply

  90. Hello Doctor,
    I recently had a CT Calcium Scan and my score was 165, all located in the Left Anterior Descending Artery. I have a total colestrol of 179, ldl is113, and hdl is 38. My doctor put me on 20 mg of a Liptor generic and a daily low dose aspirin. Why is a statin necessary in my case or is it? My only other risk factor is a father who had heart disease. I am a 66 year old male. Thanks!

    Reply

    • The statin is indicated due to presence of coronary artery disease, to stabilize disease and prevent progression and further events.

      you can follow our twitter at @MustafaAhmedMD

      Reply

  91. Sir my age 27.i have a chest pain.my doctor go and refer CT angiogram.the report says calcium level 0.and my lad distal is mild irregularities..what I can for further..it is stent require for this type of problem

    Reply

  92. Hi Dr Ahmed

    I gad an angiogram two weeks ago, it revealed a blockage. I received a letter today saying occluded lad , it says long occlusion and very difficult to visualise the proximal stump. They would discuss this in stag mdt meeting. They said my symptoms warrant early revascularisation of my lad. This worried me so I rang secretary, she said they had meeting yesterday and wish to see me regarding treatment, I eas told I needed a sent two weeks ago and now she said the notes mention sent or bypass surgery. I’m only 50 and this is terryfying me. Also the consultant can only see me in two weeks as he’s on holiday. I have to worry all this time. Will I get a choice of stent as bypass surgery is really major and I don’t really want this. Are stent a good option, I just need your advice please.

    Kindest regards

    Kevin Patterson

    Reply

    • It sounds like the disease may not be amenable to stenting given the complexity of the lesion and the anatomy. In such cases, if possible bypass surgery is often the better option. At the age of 50, long term result is critical.

      you can follow our twitter at @MustafaAhmedMD

      Reply

  93. Hi Dr Ahmad

    My mother ( Age: 62, K/C/0 D.M) went under CT angiography. Her ECG was normal.
    Following was the impression.

    – Mixed density calcified & non-calcified plaque in proximal LAD for about 12mm length causing 50% to 70% stenosis, located 7mm from the origin, with optimal distal flow.

    – Small eccentric calcified plaque in mid & distal course of right coronary artery with low grade stenosis. Small atherosclerotic calcified plaque seen in right sinus of valsalva.

    -Hypoplasia of left circumflex.

    -Dominant ramus intermedius with minimal non-calcified plaque at origin with low grade stenosis.

    – Calcium score is 93.

    Kindly advise if this requires a surgical intervention, if yes what procedure is required? Can this be controlled by aggressive medication. Any further tests required? Thank you.

    Reply

    • The need for intervention is not typically based on the anatomy alone, rather the presence and extent of symptoms and stability.

      Has a stress test been performed, are there symptoms?

      you can follow our twitter at @MustafaAhmedMD

      Reply

  94. Hello Dr Ahmad

    My mother ( Age: 62, K/C/0 D.M) went under CT angiography. Her ECG was normal.
    Following was the impression.

    – Mixed density calcified & non-calcified plaque in proximal LAD for about 12mm length causing 50% to 70% stenosis, located 7mm from the origin, with optimal distal flow.

    – Small eccentric calcified plaque in mid & distal course of right coronary artery with low grade stenosis. Small atherosclerotic calcified plaque seen in right sinus of valsalva.

    -Hypoplasia of left circumflex.

    -Dominant ramus intermedius with minimal non-calcified plaque at origin with low grade stenosis.

    – Calcium score is 93.

    Kindly advise if this requires a surgical intervention, if yes what procedure is required? Can this be controlled by aggressive medication. Any further tests required? Thank you.

    Reply

  95. Hi Doctor Mustafa Ahmed,

    Thank you for being so generous with your advice,
    I am a 47 yr old male non smoker non drinker who has had sob and chest pain
    I was admitted to hospital for 17 days after being told I have unstable angina, I underwent an angiogram that found a significant bridging of the l a d, my arteries were clear and my cholesterol was 4, they gave me a mibi scan but said the blood flow seems unrestricted through the bridge I was not scanned under stress the stress test was an ecg an hour before my mibi, but then said I have likely micro vessel disease,
    I still have Angina daily and have been taken by ambulance back to hospital to be told it’s angina. I feel that the testing should of been to establish the flow rates and maybe an mri scan, whatever is causing this is relived by gtn spray most of the time but I am on maximum nitrates and still get symptoms at rest, I have all my records and imaging but feel this bridging needs more advanced tests before ruling it out as the cause of my chest pain, and also to find out if the micro vessels and structure in the location of the bridge are causing symptoms.
    Kind regards
    Alan

    Reply

    • Difficult to to comment without seeing the pictures.

      In symptomatic cases non responsive to medicine it may be prudent to perform assessment with modalities such as iFR to determine physiologic significance.

      you can follow our twitter at @MustafaAhmedMD

      Reply

  97. Hello Sir,

    My father is 64 years old and sometimes feels chest pain slightly above the heart when he climbs the stairs or walks on moderate hilly area. As per doctor’s advice; a CT coronary angiography is performed and report says as below –
    Calcium score : 53
    Ejection fraction is 62.7%.
    Stroke volume is 69.7 ml.

    Tiny eccentric calcific plaque is seen in MLCA with no evidence of luminal narrowing.

    Left Anterior descending –
    Proximal – Small mixed density plaque is seen in proximal LAD causing 40-50% luminal narrowing.
    Mid/Distal – Small mixed density plaque is seen in mid LAD at the level of D1 origin causing 80-90% luminal narrowing. Distal LAD appears normal with no significant plaquing or luminal narrowing.
    Diagonals – D1 appears normal. D2 is a small caliber vessel.

    Left Circumflex :
    Proximal – Small soft plaque is seen in proximal LCX causing approx. 40% luminal narrowing.
    Distal – Small soft plaque is also seen in distal LCX causing approx. 30% luminal narrowing. Distal LCX continuous as PDA & PLV which appears normal caliber with no obvious plaquing or luminal narrowing.

    Please suggest is this normal or is it something where we need to act immediately ? If this requires immediate attention; what kind of treatment will be best suitable ?

    Reply

    • Cardiology evaluation and some form of stress testing is the next step.

      you can follow our twitter at @MustafaAhmedMD

      Reply

  98. I am a 59 years old women.
    I Had a CT Cardiac Scoring this week and the following were the findings:
    left main: 0,
    LAD: 324.2,
    LCX:7.71
    RCA 8.12.
    under 4mm non calcified nodule noted in the left lower lobe. Difficult to further characterize. There is no cardiomegaly or pericardial effusion.
    The cardiologist recommended to start taking crestor 10mg.
    I appreciate your comments.
    Thanks.

    Reply

  99. Hi Sir,

    This is regarding my father

    Left main : Normal
    LAD: Type III plaque in Mid LAD and 90% stenosis in distal LAD
    TIMI 3 Distal flow . Diagnols- Diffuse disease 1

    Circumflex: Non dominant 75% stenosis at ostium, TIMI 3 dIstal flow
    OMs – Diffuse disease

    RCA – 95% stenosis with thrombus in stent in Mid RCA and 100% before distal stent.

    2d echo displays 30-35% pumping immediately after heart attack and now 35-40% pumping.

    Recently PTCA to RCA was done and no blockage in RCA.Could you please let me know what else/more can be done to increase life span .

    Patient is 67 years old and diabetic.

    Thanks

    Reply

    • Depends on many factors.

      How was the LAD disease treated? It may need to be addressed
      Its reassuring that the heart function has improved,

      The most important thing is follow up, medications, lifestyle, activity, diabetes control, no smoking, and risk factor control.

      you can follow our twitter at @MustafaAhmedMD

      Reply

      • Hi

        Thanks for the reply.I shall get back to you regarding how LAD had been treated.
        Thanks you so much.
        Good day!!

        Reply

  100. Hi,

    This is regarding my father

    Left main : Normal
    LAD: Type III plaque in Mid LAD and 90% stenosis in distal LAD
    TIMI 3 Distal flow . Diagnols- Diffuse disease 1

    Circumflex: Non dominant 75% stenosis at ostium, TIMI 3 dIstal flow
    OMs – Diffuse disease

    RCA – 95% stenosis with thrombus in stent in Mid RCA and 100% before distal stent.

    Recently PTCA to RCA was done and no blockage in RCA now.

    2d echo immediately after attack showed 30-35% pumping. And now it is raised to 35-40% pumping.

    Could you please let me know what else/more can be done to increase life span .

    Patient is 67 years old and diabetic.

    Thanks

    Reply

  101. Hi,
    This question is regarding an outcome.
    LAD was repaired in an open heart surgery (leaking aortic valve repair).
    5 days after surgery, hypovolemic shock caused the heart to go into systolic anterior motion.
    Low BP was treated for over 10 hours with an inotropic drug, dopamine.
    Result – acute MI – near occlusion of LAD.
    Can SAM cause this LAD occlusion since this was just addressed in surgery 5 days prior?
    Thank you!

    Reply

  102. I am a 76-year-old With controlled diabetes and hypertension. I recently had a heart attack within the last two weeks for a 80% blockage in the widow maker. It was unblocked and a stent was put in. I did not have any heart damage since we did get to the hospital very quickly and was administered nitro and heparin.I also have an aortic aneurysm measuring 3.5. What danger am I in with the current heart attack and the 80% blockage of my widow maker vs the aortic aneurysm measuring 3.5. Will I need surgery to reinforce the aortic aneurysm if there had been damage to that area. I also had one year ago A 95% blockage of my right carotid artery which was cleaned out and been OK. It seems that these blockages are coming from a hereditary factor since my cholesterol and all my other bloodwork is all in line in fact on the low side. I had no symptoms of either it was actually stumbled by by my neurologist and the heart attack was sudden when I got terrific pain in my shoulder. If you could help me understand why this happens and if I will need surgery on my aortic artery that would help me out a lot. I am currently very anxious to know if I am in danger with this aortic aneurysm thank you

    Reply

    • A 3.5 cm aorta is unlikely to need anything done about it unless it has very atypical features or has rapidly enlarged. It will need surveillance only most likely.

      you can follow our twitter at @MustafaAhmedMD

      Reply

  103. I am 34 I had a massive heart attack my LAD was 98% blocked. So they put a stint in and put me on 75 mg of plavix once a day. It has been a year so far it seems OK. But I do get a sharp pain sometimes. But it is only for a second then gone. And also sometimes I have a feeling like I lose my breath for a sec and I just happen to check my pulse when it happens and it feels like my pulse stops when I feel like I lost my breath. What could that be my mom use to have PVCs before she passed is that the same thing. It does not happen all the time though.

    Reply

    • Difficult to say without knowing more, if worried go get a check up and discuss the symptoms.

      you can follow our twitter at @MustafaAhmedMD

      Reply

  104. I am 58 years with NIDDM since last 20 years RBB withLAHB since last 20 years history of off and on palpitations since last 37 years .I went for stress echo and TMT shows few ectopics at peak of exercise and two in recovery stage.I had no symptoms went for angio shows 80percent block in mid segment and 80 percent block in LCX stents put in LAD in December 17 now I am fine but still feel ectopics.Holter normal,Echo Normal I am worried about palpitations.Any further test is required.

    Reply

    • If there are no symptoms then likely no testing required, if there are symptoms evaluation would be advised.

      Reply

    • Depends on many factors, the significance of the lesion will certainly needs assesssing. If not chronic, then most practitioners would at least test and likely fix it.

      you can follow our twitter at @mustafaahmedmd

      Reply

  106. I am 76 year old andhaving aCoronary artery bypass surgery in Nov 2011 and I am on madicones . While walking I am having tiredness in legs not avail to walk. My Dr told me to provide the AICD . Please advice whether it is to be provided or not for my health.

    Reply

    • What is the function of the heart, are you maximally treated with medicines, have you had a full discussion about the risks and benefits?

      you can follow our twitter at @mustafaahmedmd

      Reply

  107. 42 yo female considered for bypass of LAD. LAD has genetically degenerated over time and after heart attack was medically induced as the LAD was less than 1mm in size. For bypass, would the entire heart have to exposed (median sternotomy) or would a less invasive robotic surgery be an option?

    Reply

    • Robotic approaches are possible however extremely dependent on the operator.

      you can follow our twitter at @MustafaAhmedMD

      Reply

  108. my husband has coronary artery diease age 67 had open heart surgery a year ago with 2 bypasses ..now a year later having intermittent chest pain with exertion. With a visit to ER and hospital admission had a heart cath..with failure of one bypass (100%) closure LAD..
    recommended Medical therapy with daily nitro..
    Concerned as to future risk for heart attack and death..And of course his mental outlook he is not dealing well with this news…. They did say his heart muscle was good

    Reply

  109. Hi
    Sir, Nasir here from Pakistan. I am 32 years old few months back I had chest pain and went for cardio tests. As per msct my LAD is 50 percent blocked n as per stress test it’s mild to moderate issue. Dr has recommended me angiography followed by stent. But everyone is saying me to have angiography only n never go for stent. Sir please help me out.
    Ur early response ll b highly appreciated.
    Regards.

    Reply

    • Check with the Dr the indication for a stent, a 50% blockage that is mild to moderate only is not an indication.

      you can follow our twitter at @MustafaAhmedMD

      Reply

  111. I am 49 years old and often experience congestion in my chest (specially in winter). I was advised CT angiography. Finding of CT angio carried out on 22 May 2018 are as follow:-
    – LAD: Monor osteal disease critical diseasewith calcification in proximal course.
    – LCX: Spotty calcium with mild disease in mid course. And major OM branch has critical disease proximally.
    – RCA: Dominant, spotty calcium proximally.
    Diagnose: DVCAD.
    Advised Coronary angiography.
    After Angiography (LAD only)
    * Predelatation: 90% stenosis
    * Post- stenting: Excellent result with no residual stenosis.

    After 3 months I has Thalium sacn test and finding are as follow:
    The post stress scan image show normal sized left ventricular cavety with mildly reduceduptakein the apexwhich shows reperfusion in the rest re-injectionimages. Essentially normal symmetrical tracer uptake is notein rest of the left ventricularwalls.The gated SPECT images show normal left ventricular regional wall motion with LVEF of 70%.
    _ Impression:
    1. Mid stress induced reversible myocardial ischemia -apex.
    2. LVEF 70 %

    Now in view of above all my request is that should I go for stenting of LCX or that is not required nay more.
    Regards
    Tauqeer

    Reply

  112. I am 49 years old and often experience congestion in my chest (specially in winter). I was advised CT angiography. Finding of CT angio carried out on 22 May 2018 are as follow:-
    – LAD: Monor osteal disease critical diseasewith calcification in proximal course.
    – LCX: Spotty calcium with mild disease in mid course. And major OM branch has critical disease proximally.
    – RCA: Dominant, spotty calcium proximally.
    Diagnose: DVCAD.
    Advised Coronary angiography.
    After Angiography (LAD only)
    * Predelatation: 90% stenosis
    * Post- stenting: Excellent result with no residual stenosis.

    After 3 months I has Thalium sacn test and finding are as follow:
    The post stress scan image show normal sized left ventricular cavety with mildly reduced uptakein the apex which shows reperfusion in the rest re-injection images. Essentially normal symmetrical tracer uptake is noted in rest of the left ventricular walls.The gated SPECT images show normal left ventricular regional wall motion with LVEF of 70%.
    _ Impression:
    1. Mid stress induced reversible myocardial ischemia -apex.
    2. LVEF 70 %

    Now in view of above all , my request is that should I go for stenting of LCX or that is not required any more.
    Regards
    Tauqeer

    Reply

    • What did the angiogram show with regards to the circumflex?
      Do you have symptoms?

      you can follow our twitter at @MustafaAhmedMD

      Reply

  113. HI Dr. Mustafa Ahmed ,

    kindly please ask my question :

    I had a chest CT scan for a different issue and the CT scan reveal ” heavy calcification of the LAD”

    My family doctor sent me to see a cardiologist , the cardiologist ordered a stress EKG and result where normal .

    Now I am concern as EKG stress will only show if the LAD will be 70 % or more blockage will show up on EKG result.

    How about if my LAD is about 65% blocked and I may be close to a fatal heart attack .what can be done to reverse calcium from LAD , also it was normal what cardiologist did ? should he have sent me to for more investigations ? my family doctor was told that I need to see a cardiologist so I can make a calcium score .

    please advise ?

    thank you so much

    Reply

    • A blockage under 70% is not necessarily dangerous. If treated with medicine and modification of risk factors, the outcome can often be better than with treatment using procedures. The stress test will typically uncover lesions that are felt to be significant.

      you can follow our twitter at @MustafaAhmedMD

      Reply

  114. Dear all

    Im 48 years old female and I had acute coronary syndrom almost 3 weeks ago followed by tachycardic episode few days later,still waiting to hear from my cardiologist to discuss issues..My CT coronary scan with contrast revealed myocardial bridge involving the distal LAD.My troponin and CRP were elevated and ECG shown T wave inversion.Is it possible that this bridging is responsible for what has happened to me?Apart from that nothing wrong was found.Many thanks for any advise on this.

    Reply

      • High-resolution, cardiac gated Computed Tomography of the chest.

        Calcification was analyzed using ScImages’s volumetric calcified plaque analysis software.

        Thank You!

        Reply

  116. Dear Sir, Doc Please Help me and Guide me What I Do, WHich Method is Best, Surgery or Stunt.

    Left Main Stem >> Normal Bifurcating Vessel

    Left Anterior Descending Artery >> Mild Mid Disease

    Left Circumflex Artery >> Good Size OM1 Shows mild Proximal Disease

    Right Coronary Artery >> Dominate Vessel with Tight Proximal Stenosis Followed by Total mid Occlusion.

    LV Angiogram >> Good LV Systolic Function 2, Ejection Fraction 60%

    Reply

    • This decision needs to be made by the treating team with access to you, the clinical picture and the angiography films.

      you can follow our twitter at @MustafaAhmedMD

      Reply

  117. Hi doctor

    CT coronary angiogram shows mild diffuse irregularities. What does it mean ? Should I be on medicine ? Especially ecospirin ?

    Reply

  118. Hi doctor

    CT coronary angiogram shows mild diffuse irregularities. What does it mean ? Should I be on medicine ? Especially ecospirin ?

    Reply

  119. hi doc,
    age 38 years male
    tmt came positive and following angiogram i was diagnosed as follows:

    left anterior descending artery-tyoe 3 vessel shows proximal and mid mild disease. diagnol D1 is medium sized vessel with ostio-proximal total occlusion, distal vessel filling from collaterals.

    the doc tor who did my angiography has put me on medical management and ptca to LAD/D1(bifurcation) if symptoms persists

    Reply

    • Appears appropriate management of diagonal disease if determined by treating physician.

      you can follow our twitter at @MustafaAhmedMD

      Reply

  120. Hello doctor.
    My father’s Angiography report revealed concentric non calcified plaques in the proximal and mid second diagonal with 95% luminal stenosis. Please prescribe for future course of action.

    Reply

    • Diagonal lesions alone are typically treated with medicines.

      you can follow our twitter at @MustafaAhmedMD

      Reply

  121. Hi
    severe proximal atherosclerosis with a stenosis of 80% in the proximal RCA.
    The mid vessel also has an eccentric plaque which is 70% stenotic.
    The L main has an ostial narrowing 50% with a shelf – like plaque.
    The very proximal LAD Has a very tight stenosis of 90%+
    The above is the result of my angiogram.
    I was told to do no physical exertion until PCI is performed – which should be ASAP before 2 weeks.
    My question is PCI bypass or a stent area.
    Thank you.

    Reply

    • If a good candidate would recommend speaking with a surgeon and an Interventionalist. I can’t comment specifically without seeing the films.

      Please follow our Twitter at @MustafaAhmedMD

      Reply

  122. Hi

    My friend had chest pain who is working in KSA, he immediately went to hospital for a check up.
    his report says:

    LM: Normal
    LAD: Proximal Long 70% disease
    LCX: Mid Segment 70% disease, Distal 60-70% disease (sizable vessal)
    RCA: Dominant, Pressure Damp Upon Engagement, Proximal 60% disease

    What do you suggest does the Heart Surgery required in this case or it can be cured by medicine or other treatment?

    Reply

    • Films need to be reviewed by both a surgeon and an interventionalist. Medicines are required regardless and with the pain presentation some form of intervention is likely required and depends upon local team approach, resources and availability. There may be advantages, to be discussed with the team, to either of the options.

      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.

      Reply

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