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Coronary CT Angiogram
From Irshad Khan, New Delhi, India
I have taken last week CT Angiogram and its findings are worrisome. The main impressions are:
Calcium score: 18, Soft plaques seen in proximal LAD and D1 segment.
LEFT CORONARY ARTERY
LM - Normal
LAD - (Prox/Middle/Distal)- Type -III LAD with normal course. Focal Eccentric non-calcified plaque seen with moderate luminal narrowing.
Diagonals----
D1 ----- Single large D1 branch seen with normal course. Mid vessel reveal plaquing with moderate luminal narowing.
Obtuse Marginal Branches
OM1 --- Normal
OM 2 --- Large OM2 artery seen with distal branching. Proximal vessel reveal focal luminal narrowing with approx 60-65 % stenosis.
Please advise me what course of treatment is advisable.
I have taken last week CT Angiogram and its findings are worrisome. The main impressions are:
Calcium score: 18, Soft plaques seen in proximal LAD and D1 segment.
LEFT CORONARY ARTERY
LM - Normal
LAD - (Prox/Middle/Distal)- Type -III LAD with normal course. Focal Eccentric non-calcified plaque seen with moderate luminal narrowing.
Diagonals----
D1 ----- Single large D1 branch seen with normal course. Mid vessel reveal plaquing with moderate luminal narowing.
Obtuse Marginal Branches
OM1 --- Normal
OM 2 --- Large OM2 artery seen with distal branching. Proximal vessel reveal focal luminal narrowing with approx 60-65 % stenosis.
Please advise me what course of treatment is advisable.
Q:"So, you have a decision. Do you a) stay as you are because you feel good enough on meds with a normal quality of life, or b) have the 70% lesion treated ?
And if they said they could also open the LAD, giving two main feeds back to the left ventricle would you have this done also? so you don't rely on just one vessel?
I'm just wondering what your decision would be if this was your case."
_______
...Reading your posts strongly indicates to me you do not have any understanding with merit of collateral vessel formation. Your responses appear preachy, some truths/half truths and platitudes of of common knowledge that cannot be disputed and offer no enlightenment on the subject. How can someone answer your report as evidence regarding (whether true) of how convoluted your vessel configuration you say and then ntermingle that with assumptions you make that doesn't in my opinion make sense...If you could stay focussed and limit your rhetoric to facts that would help communication.
It maybe my fault to understand but your posts seem preachy, making generalizations, half truths/ truths, etc. and rather than just telling, present some facts that supports your proclamations. You are permitted to quote some authority to avoid any plagiarism inferences and because this forum is a fair user of copyrighted material it is permissable to quote that source as authority and express your opinion and accept or reject my comments. So go for it!:)
For some clarification of your posted questions lets start with the above quote of your question because I don't understand what you are talking about? Doesn't make sense, but now that you have more information from a member you appear top modify. Please stay away from what happened to you and your condition, what doctors have told you unless you can support with some logic to support the hearsay! We can discuss logic, but hearsay can't be questioned as you may understand....lets maintan some intellectual integrity so we can all learn.
Thanks and it may be awhile for an answer, but lets make this an informative exchange of ideas that have merit. Take care,
Ken
And if they said they could also open the LAD, giving two main feeds back to the left ventricle would you have this done also? so you don't rely on just one vessel?
I'm just wondering what your decision would be if this was your case."
_______
...Reading your posts strongly indicates to me you do not have any understanding with merit of collateral vessel formation. Your responses appear preachy, some truths/half truths and platitudes of of common knowledge that cannot be disputed and offer no enlightenment on the subject. How can someone answer your report as evidence regarding (whether true) of how convoluted your vessel configuration you say and then ntermingle that with assumptions you make that doesn't in my opinion make sense...If you could stay focussed and limit your rhetoric to facts that would help communication.
It maybe my fault to understand but your posts seem preachy, making generalizations, half truths/ truths, etc. and rather than just telling, present some facts that supports your proclamations. You are permitted to quote some authority to avoid any plagiarism inferences and because this forum is a fair user of copyrighted material it is permissable to quote that source as authority and express your opinion and accept or reject my comments. So go for it!:)
For some clarification of your posted questions lets start with the above quote of your question because I don't understand what you are talking about? Doesn't make sense, but now that you have more information from a member you appear top modify. Please stay away from what happened to you and your condition, what doctors have told you unless you can support with some logic to support the hearsay! We can discuss logic, but hearsay can't be questioned as you may understand....lets maintan some intellectual integrity so we can all learn.
Thanks and it may be awhile for an answer, but lets make this an informative exchange of ideas that have merit. Take care,
Ken
It very often takes more than one test to back up a patients condition. In 2007 I had emergency stenting to my Left Circumflex and it was seen how my LAD was totally blocked, but fed by a few collaterals. My Cardiologist felt 100% sure that I would have suffered heart muscle necrosis. He ordered an echoscan which showed great results and a 70% LVEF. With the size of my LAD and knowing that the collaterals had been closed for a considerable period of time due to the blockage of their source in the LCX, he ordered a nuclear scan. Now keep in mind that I still had a lot of angina even with medication. You would expect the nuclear scan to show that insufficient blood was reaching the left ventricle. The results shocked everyone, they showed that there was no shortage of blood. So, the nuclear scan AND the echo scan showed perfect results and showed my heart was in great shape with no problems. My Cardiologist said "If you hadn't had a heart attack, emergency stenting and we hadn't seen your Arteries with an angiogram, you would have been classed as fit and healthy with no heart problems, due to those results."
So the gold standard Angiogram was the test that revealed my problems in 2007.
Now moving to 2010 after lots of stenting, it was a mystery why angina was still occurring. Angiograms revealed nothing, everything looked open and normal, so a stress echo was ordered. This revealed ischemia to the distal LAD, in the same area as a 2mm artery. After a few months collaterals fed into this area and killed all angina symptoms. So the gold standard this time was the stress echo scan.
This is why I get annoyed when Doctors simply order a EKG. When most people are laying still on a bed, they have no symptoms and the results are normal. Then walking back to the car park they feel the symptoms again, but feel confused because they've just been told it is nothing to do with their heart. Many heart attacks occur without ST changes and so I often wonder why an EKG is taken so seriously and prevents further investigation in many cases. Perhaps it's to save money? Perhaps the Cardiologist genuinely feels an EKG is sufficient?
So the gold standard Angiogram was the test that revealed my problems in 2007.
Now moving to 2010 after lots of stenting, it was a mystery why angina was still occurring. Angiograms revealed nothing, everything looked open and normal, so a stress echo was ordered. This revealed ischemia to the distal LAD, in the same area as a 2mm artery. After a few months collaterals fed into this area and killed all angina symptoms. So the gold standard this time was the stress echo scan.
This is why I get annoyed when Doctors simply order a EKG. When most people are laying still on a bed, they have no symptoms and the results are normal. Then walking back to the car park they feel the symptoms again, but feel confused because they've just been told it is nothing to do with their heart. Many heart attacks occur without ST changes and so I often wonder why an EKG is taken so seriously and prevents further investigation in many cases. Perhaps it's to save money? Perhaps the Cardiologist genuinely feels an EKG is sufficient?
If you have not already taken, I suggest, you may consider to go for a Thallium test that would give images of blood flow in coronary arteries and even collaterals. Cath angio cannot provide any idea of these.
If you exercise and climb stairs w/o any pain/symptoms, I do not think you have ischemia (angina). So where is the need for a by-pass? One should go for a cath angio if there are symptoms and it would help in detecting blockage that could be dealt with stent/s or in worst case scenario by pass. Cath angio is a diagnostic tool and is more accurate than CT angio. In a CT angio dye is injected in a vein and after mixing it goes to arteries that affects clarity. secondly, as my Dr. told me, percentage narrwoing does not convey much sense in a CT angio.
If you exercise and climb stairs w/o any pain/symptoms, I do not think you have ischemia (angina). So where is the need for a by-pass? One should go for a cath angio if there are symptoms and it would help in detecting blockage that could be dealt with stent/s or in worst case scenario by pass. Cath angio is a diagnostic tool and is more accurate than CT angio. In a CT angio dye is injected in a vein and after mixing it goes to arteries that affects clarity. secondly, as my Dr. told me, percentage narrwoing does not convey much sense in a CT angio.
"In my case it is vulnerable plaque as told by doctor"
I assume from your posts, that on arrival at the hospital, your symptoms diminished with anticoagulant medication? You was very fortunate that the erupted vulnerable plaque didn't cause a blockage that required emergency intervention. It sounds like a blood clot formed at the location of the eruption, but you passed the vulnerable plaque through.
I don't think angiograms are the best solution for detecting vulnerable plaques, unless the vessel wall is bulged into the lumen. Vulnerable plaque sits behind the artery lining, and an angiogram only basically sees where blood is flowing. A calcium scan would also not be very accurate because this will only detect calcified plaque, which vulnerable plaque is not. Your plaque is mainly the soft fatty type. I think perhaps a CT or MRI may detect it, but not sure because it would really have to be evident by bulging as a clue. You say they suggested a bypass, but bypass WHAT exactly? If you can't see the vulnerable plaque, how would you know where to graft? and this wouldn't make it less of a risk of eruption anyway. The only way to reduce the risk of eruption is to cover it with something like stent. I think your best option by far would perhaps to follow a very strict diet, raise your HDL and get LDL right down in the hope your body can remove a lot of the plaque on its own. If you continue to have high LDL levels, then it's likely the vulnerable plaque will just continue to get fed and grow. What do you think?
I assume from your posts, that on arrival at the hospital, your symptoms diminished with anticoagulant medication? You was very fortunate that the erupted vulnerable plaque didn't cause a blockage that required emergency intervention. It sounds like a blood clot formed at the location of the eruption, but you passed the vulnerable plaque through.
I don't think angiograms are the best solution for detecting vulnerable plaques, unless the vessel wall is bulged into the lumen. Vulnerable plaque sits behind the artery lining, and an angiogram only basically sees where blood is flowing. A calcium scan would also not be very accurate because this will only detect calcified plaque, which vulnerable plaque is not. Your plaque is mainly the soft fatty type. I think perhaps a CT or MRI may detect it, but not sure because it would really have to be evident by bulging as a clue. You say they suggested a bypass, but bypass WHAT exactly? If you can't see the vulnerable plaque, how would you know where to graft? and this wouldn't make it less of a risk of eruption anyway. The only way to reduce the risk of eruption is to cover it with something like stent. I think your best option by far would perhaps to follow a very strict diet, raise your HDL and get LDL right down in the hope your body can remove a lot of the plaque on its own. If you continue to have high LDL levels, then it's likely the vulnerable plaque will just continue to get fed and grow. What do you think?
None of the doctors suggested me to go for stress test till now. Why I do not understand. In my exercise plan I climb seven stories daily twice without any indication of chaste pain. I am normal in all my daily activities.Even sexual activity. When i asked to the doctor if I should go for any tests he said you are perfectly ok on examination and I do not need any test report for your treatment. I go daily for sweeming too. I feel your health indicates how the test reports will be. It will be better not depend on test reports only. Many times they may be misleading.This is my experience I wanted to share with every body.Thank you all.
"That is why to open an occluded vessel redistributes blood flow through the newly open occlusion and that puts pressure on other vulnerable segments of the cariovascular system and possilbly shut down the collateral flow and not that not effectively open the closed vessels"
Well, nothing is really 100% understood. For example, I have collaterals feeding the distal LAD, just a small section due to a blockage which is in a vessel too small to stent. The vessel is around 2mm. The collaterals are fed from the distal LCX. When I had my LAD opened, many collaterals closed, but not those feeding the distal section. However, in my recent MI, the lower section of the LCX was virtually shut off and those collaterals did then close up, making me feel even worse. When stented, after about 3 days, those collaterals re-opened again and everything returned to normal.
I am seeing my cardiologist next monday to discuss having a drug eluting balloon, to open the distal LAD. My very first attack in 2007 was particularly bad and life threatening because my LAD had apparently been totally blocked for years, but there was collateral feed from the LCX. Now this vessel was blocked 99% and blood flow was too low for collateral feeds to the LAD. It was basically a double whammy.
I agree it's common to have lesions form at bifurcations, especially LAD/LCX and Mid RCA.
I know Plavix is related to preventing clotting, which is why I said "turbulence in a stent can cause clots in that stent though, which is why plavix is so important"
Well, nothing is really 100% understood. For example, I have collaterals feeding the distal LAD, just a small section due to a blockage which is in a vessel too small to stent. The vessel is around 2mm. The collaterals are fed from the distal LCX. When I had my LAD opened, many collaterals closed, but not those feeding the distal section. However, in my recent MI, the lower section of the LCX was virtually shut off and those collaterals did then close up, making me feel even worse. When stented, after about 3 days, those collaterals re-opened again and everything returned to normal.
I am seeing my cardiologist next monday to discuss having a drug eluting balloon, to open the distal LAD. My very first attack in 2007 was particularly bad and life threatening because my LAD had apparently been totally blocked for years, but there was collateral feed from the LCX. Now this vessel was blocked 99% and blood flow was too low for collateral feeds to the LAD. It was basically a double whammy.
I agree it's common to have lesions form at bifurcations, especially LAD/LCX and Mid RCA.
I know Plavix is related to preventing clotting, which is why I said "turbulence in a stent can cause clots in that stent though, which is why plavix is so important"
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