Is Cath really necessary?

[terrylane]

I had angioplasty in May, with 3 stents placed in my circumflex and right coronary arteries.  These were for blockages of 70-80 %.  I recovered well and went through cardiac rehabilitation for 40 weeks.  At a recent visit to my cardiologist, I mentioned getting some chest tightness and shortness of breath when my dog ran out into traffic.  He asked about fatigue, I admitted to some on occasion, and he ordered a stress test to check for restenosis.  The result of the stress test indicated anterior wall ischemia.  My stents, however, were performing just fine.  Now he wants me to have another cath to see if I need another blockage cleared.

Here's the thing.  It turns out that during the initial cath in May, they found two places where i had 30% blockage and did not do angioplasty, as the blockages were not great enough to warrant that.  One of those two places was on a diagonal artery on the anterior wall.  So it appears that this is that same blockage and that he wants to see if it has grown since May to the point of needing treatment.  While I want to keep my heart as healthy as possible, I also want to avoid invasive procedures as much as possible.

I am diabetic, and did not get chest pains before my initial problems.  So it is not surprising that I have not had angina problems now either.  But I am not experiencing the sorts of heavy legs, shortness of breath, nausea I felt prior to the May procedure, either.  I have had a few incidents of tightness and of shortness of breath.  I am 50 years old and obese.  My blood pressure is now under good control and my heart rate has dropped 15 points since the angioplasty.  Most importantly, I am quite anemic and we have not been able to determine a cause.

Isn't it possible that this ischemia is from the 30% blockage we know I had in May?  Isn't it unusual for a blockage to grow that much in 5 months?  Would the anemia contribute to the ischemia-- the blockage lets less blood through under stress and the blood that gets through is not oxygen-rich, so the ischemia looks worse than it would otherwise?  I do not want to ignore the problem, but I have to wonder if continuing to diet and exercise and to monitor symptoms might not be the best approach.  Is it really necessary, as my cardiologist suggests, to have a cath immediately (this week, he says) and to prepare for the likelihood of more angioplasty and stenting?

[terrylane]

Thanks for responding.  I'm not foolish enough to turn down the angioplasty if it is needed.  What I keep wondering, though, is if they couldn't study the pictures from my May tests and those from my recent test and see if the level of ischemia has changed.  Shouldn't a comparison of the results give us a good indication of whether the conditions in this area of my heart have deteriorated or are at the same level.  If they are at the same level, it seems to me that would indicate that the blockage has not grown significantly.  If the conditions have changed for the worse, bring on the cath to see why.  Does that make sense?

[Flycaster305]

You absolutely could go from 30% blockage to a blockage percentage  that needs stenting in a very short period of time.  In a two year time frame I had eight stents.  I'd not fight the suggestion of another angioplasty, it could save your life.
Best wishes, please keep us informed, many of us have had the same question you asked.