Can you please explain the condition based on this report?

[n_sinha_p]

Hello,

My Father-In-Law's angiography report (done yesterday on 29th Oct) reads the following:
Diagnosis: CAD - AWMI
Approach: Right Radial
Catheter Used: Tiger 5F
Contrast Used: Omnipaque

Coronary Angiography
=================
LM: Distal 60% Lesion
LAD: Ostial 99% eccentric lesion
LCX: Mild plaquing (+)
RCA: Proximal to mid 90%, aneurysmal lesion

Complications: Nil
Impression: LM + Double Vessel Disease
Recommendation: Early CABG


Can someone explain the patients condition in simple terms please? Does this means he is VERY CRITICAL and needs IMMEDIATE stenting/balooning/open heart surgery? At the moment, he appears to be fine. Can he make a short air travel to get better medical facilities? Does he requires an air-ambulance for the same?

An early response would be much appreciated.

Thanks in advance.

[ed34]

again this contradicts my situation. I worked in the building trade with my totally blocked LAD and was filling 6 skips on somedays using a wheelbarrow. I was incredibly fit. It wasn't until my LcX became blocked that I had any issues. So I don't agree that the heart can only be supplied with 30% through collaterals. In fact, if you look at my angiogram report, you can see how my RCA is completely bypassed halfway down. The collaterals loop around the blockage and the width looks identical to the original vessel. I personally was shocked, as was my cardiologist to learn that my LAD was full of plaque and totally blocked at the top. My echo was perfectly normal, no enlargement, or thickening and an EF of 70%. I agree they don't open with all people, but surely in the case of the poster, a 99% blockage in the LAD would make the patient very weak indeed and this leads me to believe there are collaterals at work.

[Ger57]

Ostial blockage is more risky as proximal. As the proximal blockage is really inside the vessel itself, the ostial blockage is at the root, so in this case at the bifurcation with the LCx. (depends on anatomy)
This makes it imo more critical and also more difficult to stent because of high risk for plague shift.

I read that collaterals can supply the heart with blood to only ~30% of the normal supply. If they are formed (they do not open up in everyone) they would solve the criticality of the situation.  
They will keep you alive as long as you take it easy, but could be insufficient in situations where the heart has to work really hard.

[ed34]

hmm not necessarily so. My LAD is 100% blocked in the proximal section and yet I have no heart damage whatsoever. My LAD is retrograde filled via the LCx which obviously means collaterals are busy at work.

[Ger57]

I am nor a cardiologist, but a 99% blockage in the LAD in the ostial position seems very critical to me.

The left anterior descending (LAD) supplies blood to large areas of the heart. This means that if this artery gets abruptly and completely occluded it will cause a massive heart attack.

[tacolino]

Hi there. I can understand your concern. Firstly I must stress to you that its expert cardiology info you require. Its so important, you cant afford to get it wrong. I will try explain some of your post as best i can, you must remember I am not a doctor. But anyway I will try to give some explanation.
CAD, that is coronary artery disease. It means arteries which are partially or completely blocked or obstructed in some way.  Awmi is a problem with the Anterior artery walls.
The problems are possibly near blockage of 2 arteries, the left anterior descending artery (LAD) and the right coronary artery. I cant tell you what needs to be done, i certainly am no qualified for that in any way. But the 2 arteries need to be fixed, i would think without delay. You need advice on whether it can be stented but, as the report suggests bypass graft/ surgery, it may be necessary for the surgery. (They actually suggest an early intervention) Try and keep positive and get the best advice, but i guess that an intervention is necessary. On the bright side once the surgery is complete, if the steps the patient gets for the future are followed, they will do well. It would be very important to heed the medical advice given.
Also the angio report quoted does not mention his BP or his EF % ?, they are usually on it, just thought i would mention this.