Artery Block - What to do Afterwards?

[terk]

Please, please help. My husband (59, relatively active, cholesterol normal range, and taking metoprolol for afib) had a stress test with the dye two days ago and they found a blockage in one artery, probably around 70% as guessed by the cardiologist.

We are still in shock at this finding and have been on the Internet ever since trying to learn more about this problem.

We are going back to the doctor in ten days for a full consult but his preliminary remarks after the test was that it’s not as bad as it could be because not so much the percent blockage that’s important in his case, but that the size of the abnormality was relatively small. (Isn’t percentage of blockage related to size?)

Therefore he doesn’t recommend doing anything right now but the Internet says the next step after this discovery is a picture of the heart with another dye to accurately measure the blockage. Should we push for this next step?

We asked and he did say that the blockage will gradually get worse over time, but they don’t fix it until it is at least 70% blocked as less than this rarely limits blood flow and the risks of fixing it outweigh the benefits. He said to monitor the situation for symptoms – especially under stress. And stay active. So if we don’t do anything, how in the world would we know when we reach this point?

The ‘Net also said statins are usually prescribed at this point but he didn’t suggest any meds either – should we press for this at our meeting?

And this is the scary part – supposedly the build-up could break off any time and clog the artery causing stroke or death. Isn’t this like a time bomb just waiting to go off if we don’t do something?

It just seems like we should be doing something.

The information on the Internet seems to contradict our cardiologist’s lack of proactive treatment for this. Please, what would you prescribe for your patient with similar circumstances.

I cannot thank you enough for this service.

Teresa K.

[runnertom]

   I don't know what the doc might say but I don't think one 70% blockage should be cause for panic. I am somewhat suprised that a statin wasn't prescribed immediately regardless of his cholesterol level. Studies have shown improved survival chances regardless of baseline levels.
   I don't think there should be a big concern about the blockage "breaking off". Blockages are really lesions within the artery wall rather than junk clinging to the inner wall. They cause a heart attack when they burst and release materials that then cause the clot (think of a pimple popping). It has been found that older blockages in the range of 70% and higher are responsible for relatively few infarcts. The young lesions around 30% are often to blame. Statins are thought to result in a toughening of the outer skin of the lesions making them less likely to rupture.
   I know its a shock to hear you or your husband are in this situation. It happened to me at age 54 with 90 and 99% blockages. I had bypass surgery which your husband will no doubt not need with agressive medical management.

[Cleveland Clinic]

I am assuming he had a positive stress test ( with dye?) and not a catheterization. If so then he needs a left heart catheterization to further define the amount of blockages, and see what treatment needs to be initiated. Sure medical therapy can be started now and this should include a full dose aspirin, and a statin such as lipitor or crestor in addition to his metoprolol. His blood pressure should be well controlled with goal of systolic of less than 135 mm Hg.
A left heart catheterization in this setting, as well as stenting, has not been show to decrease mortality unless you have diabetes or proximal left main disease. For this rare occurrence the diagnostic left heart catheterization is recommended. He should also have an echocardiogram to assess his lv function ans well as to diagnose any valvular heart disease.