Can heartblocks be dissolved with medicines alone?

[DEVAS1509]

I am a male, 61 years old. I am a controlled diabetic (HbA1c = 6.2). Blood pressure and cholesterol are well within limits. Recently, after experiencing some uneasiness during climbing stairs, I went for an Angiogram. The Report says as under:

LMCA:      Normal

LAD:     Type III vessel, has 80% stenosis proximally.

Diagonals: D1 - 1.5mm size vessel, has 90% ostial stenosis

LCX :  Non dominant vessel, is totally occluded in the mid segment

Marginals : OM1 - 2.5 mm size vessel, has 80 percent stenosis proximally

RCA:   Dominant vessel, has 70% stenosis in the distal segment

PDA:  Normal

PLV:  Subtotally ocluded at the ostium. Fills faintly antegradely and by collaterals from the left system

Final diagnosis:  Triple vessel disease

Recommendations:  CABG surgery

My cardiologist initially suggested placing of two stents and medication for the removal of the other blocks. After a week of medication, he is of the opinion that efforts can be made to remove all the blocks with medications only. He wants me to continue with the medicines for a month before deciding on the necessity to place stents. He is a great and kind doctor and I have full faith in him. But I want to know as to how serious is my present heart condition. Is one month waiting a risky period for my condition? Can anything happen during the intervening period considering the report details? Can blocks of this dimension be dissolved with medicines. The terms in the report are Greek and Latin to me. Will any of you be kind enough to enlighten me on my condition?

[bobthom]

You may want to look up NATTOKINASE.  Not a cure but some evidence suggests it can help some people.
DISCLAIMER:  I am NOT a doctor.  You should only accept medical advise from a licensed proffessional.

[Ger57]

About the report:
The heart is supplied with oxygen through several coronary arteries (LMCA,LAD,RCA,LCX) which each have side branches (D, OM). Proximal means colse to origin of artery, distal is further down the line
Often symptoms appear when arteries are blocked more than 80%.

The symptoms you have are probably from the 3 blockages that are >80%
The two 80% blockages might be stentable.
The 90% blockage is probably in a too small vessel to stent
The 70% blockage is not probably not crucial

Your doctor advised to try medication alone. If after 1 months the medication alone does appear not to suffice, two stents can help restore blood supply to an sufficient level.

This sounds like a good plan to me.
The 80% blockages are not critical now.
The 90% is a bit more serious of course, but as it is a small vessel, treatment option are probably limited to  medication.

[DEVAS1509]

Thanks for your informative reply. The only point that remains ambiguous to me is as to what improvement is expected after the medication for one month. Do the dimensions of the block change after medication? How the improvement will be detected? will it involve one more angiogram?

[Ger57]

The effect of the medication on the dimensions of your arteries is minimal, so it is not necessary to make another angiogram. It will look just as the previous one.

The symptoms you experienced before, hopefully disappear with the help of the medication in the coming weeks. That is the detection of the improvement.

If the improvement is big enough, your cardiologist will probably advise to continue treatment with medication alone.
If improvement is not enough, he might advise that placing multiple stents is the way to go.

[DEVAS1509]

Thanks a lot.

[DEVAS1509]

Today I consulted another cardiologist who advised me to go for bypass surgery once and for ever instead of going for two stents for the time being. He says keeping stent for two blocks and leaving the other two blocks as such will aggravate the unattended blocks sooner or later which will necessitate stenting them at that stage. I am just curious to know as to whether stenting can be done in a piecemeal manner in unavoidable situations like financial insufficiency etc.

[Ger57]

Yes, so many opinions as there are cardiologists :-(
I am not a cardiologist and can not advice you what is the best treatment for you. Probably  no one knows for sure and the future will tell...

Here in the Netherlands, many hospitals (although not all) can instantly place a stent when a person is brought in with critical coronary blockages. I do not know how the situation is in India. You could inform about that.

[DEVAS1509]

Thank you so much.

[Ger57]

Blocks in arteries can not be removed with medication.
The only way to "unblock" an artery is by dilating the artery with a balloon catheter (and placing a stent after the dilation).
Also a blockage can be bypassed with CABG surgery.

I think you doctor referred to medication that relaxes/dilates the arteries a little so there is a bit more room for the blood to flow through. These are vasodilators like nitroglycerin.

Also betablockers may help by reducing the oxygen demand of the heart.
Other medication can help to prevent progression of the blockages.

[DEVAS1509]

Thanks