SINGLE VESSEL DISEASE

[JIBAN_KALITA]

This is my angio report. I want to know the severity of my condition

CATHETER USED
- TIG 5Fr
- Right radial artery route
                                                                               PRE ANGIO PRESSURE(AORTA): 125/80 mmHg

LEFT MAIN: NORMAL
LEFT ANTERIOR DESCENDING :
                                 - Normal
                                 - D1: Small
                                 - D2: Mild desease in proximal part
LEFT circumflex artery
                                 - Normal
                                 - OM1/OM2:NORMAL
                                 - OM3: Moderate size vessel, 70-80% stenosis in proximal part
RIGHT CORRONARY ARTERY
                                 - Mild disease in mid segment
                                 - PDA: NORMAL
                                 - PLV: NORMAL
IMPRESSION:
                        CAD: SINGLE VESSEL DISEASE

[ed34]

I didn't say permanent damage, or irreversible damage did I? There are varying amounts of damage just as there is pain. But, no matter what you say, there is damage occurring to some degree. Of course there is, the poor cells are trying to operate normally but there isn't enough oxygen to go around. Have you seen what happens to cells deprived of oxygen? You would know if you submerge yourself underwater with no breathing apparatus for 5 mins. Why would collaterals open up if no damage was occurring? what would be the point if everything is fine? It takes a short period of time for cells to repair themselves if collaterals open up, but if the pain continues I would stop. With regards to the PCTI reports your posted. I am shocked at their age. It uses in one case, patients from one state in the early 90's. Angioplasty has come a long way since then. It also says long term studies weren't included which is why they aim at 3-5 years.

[Circa49]

I'm sorry, but what you say is simply not true regarding damage.
First of all there are degrees of angina. The symptoms vary from individual to individual.   I can feel subtle precursors to standard heavy chest pain,  in my arms, and even very mild chest indications long before "damage" is done to my heart.
You have the choice to either stop exercise or to continue in a manner which, while you feel something, "damage" is not being done.

Each individual is different,  but to suggest there is damage being incurred every time you feel any form of angina is simply incorrect.

In many people,  as they exercise, and feel some small discomfort, if they simply ease up a bit,  they can often experience both dilation and the addition of collateral circulation.  In fact the collateral circulation will often not kick in until some mild angina has taken place.
This is well documented in the literature and can go under the names of "walk through angina"  or  "warm up angina".    No one is  suggesting that every time this happens that permanent damage is being done.  Indeed,  I have corresponded with several of the authors of these articles and they all make it clear to keep up daily exercising even though I may feel some mild angina at times early in the routine.

Again,  everyone is different and should discuss their particular symptoms with their own doctor.  
.
The main point of my previous post was about the need for a stent given the individual's single blockage of 70% to 80%.
For individuals who are experiencing stable angina that is not causing significant discomfort,  there are no studies suggesting that a stent will either help avoid a heart attack or death.  
It will however lessen angina in many cases,  which as I said,  was reason enough for some people to go through with stent placement.
That was the main point in posting a link to The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines for stents and bypass.

I don't want to get sidetracked on my own experience of mild angina during my early phases of exercise.  

[ed34]

Well I have a couple of comments about your statement, in particular, aimed at your health. You say you suffer angina symptoms in the first few minutes of a workout. You know that angina symptoms in the chest tell you something right? that your heart is being damaged. As the symptoms wear off, I wonder what is happening? are you opening collaterals or something? I had this very conversation with my cardiologist 3 years ago. He said "We could destroy the cells ability to cause pain, so you no longer have the ability to feel pain". I said "well what happens if I have a heart attack and feel nothing, do I die". He sat in silence for a couple of minutes and said "Actually that's not such a good idea I was really thinking out loud. You are right, pain indicates damage occurring and we need to be able to monitor that through you". I had symptoms like yours before my heart attack, where I would receive chest pains for a period of time and then be fine for the rest of the day. I just hope you don't end up having a heart attack.

[Circa49]

I understand that is UK hospital policy.
There are different guidelines in the USA since 2011.

2011 ACCF/AHA/SCAI Guideline for Percutaneous
Coronary Intervention

http://circ.ahajournals.org/content/early/2011/11/07/CIR.0b013e31823ba622.full.pdf

The findings from individual studies and systematic reviews
of PCI versus medical therapy can be summarized as
follows:
• PCI reduces the incidence of angina.82,99,104,107,108,125
• PCI has not been demonstrated to improve survival in
stable patients.119,121,122
• PCI may increase the short-term risk of MI.82,121,125,126
• PCI does not lower the long-term risk of MI.82,

That is only a summary, but one can look at individual criteria for more specific situations.

Class III: HARM
1. CABG or PCI should not be performed with the
primary or sole intent to improve survival in patients
with SIHD with 1 or more coronary stenoses
that are not anatomically or functionally significant
(eg, 0.80, no or only mild ischemia on
noninvasive testing), involve only the left circumflex
or right coronary artery, or subtend only a small
area of viable myocardium.30,53,60,61,94 –98 (Level of
Evidence: B)

Of course,  as I said earlier,  if the stable angina symptoms are significant,  and the patient finds them unacceptable,  then it is acceptable to place a stent.

I have a blockage in my mid LAD of over 70%.. exercise daily in a vigorous manner,  including some angina in the early minutes and have no need for beta blockers.   I run and bike and have done so for years.
I do take a statin and aspirin and thus far, over the past 3.5 years,  the symptoms do not seem to  be increasing.

Since I do not have symptoms of great enough significance and since there is no prevention of a heart attack to be gained,  I have chosen to not           have a stent placed,  though I am open to the idea at some future date.
BTW,  my angina is only felt during fairly significant exercise.
Others,  feeling the same angina,  might well opt for a stent.

For now,  I have not read any studies showing I would benefit any more than I currently do from statins, aspirin, and a significantly altered diet.
Not every individual has blockages that advance/worsen when doing what I am doing,  so it is not inevitable that one would eventually need a stent.

I am more than open to any new study showing otherwise.

[ed34]

I'm going by UK hospital policy where any blockage above 70% is stented because the plaque cap can easily break free and cause a heart attack or death. Also once an artery is over 70% blocked, there is not sufficient blood passing through when the heart is working hard or stressed. If a person has a happy desk job, it could be 99% blocked before any problem is found. As with meds, my point was meds for life, not short term. If angina if felt, then a beta blocker will be prescribed for life if the blockage is left. Beta blockers have lots of side effects for many patients. Plavix is nothing to worry about, it's short term. Then there's the logical benefits. Why not treat the blockage now? why wait while suffering meds until it eventually needs to be treated? It's a bit like saying "Doc I have a splinter in my leg, but can we leave it until it goes septic".

[Circa49]

While the blockage is above 70%,  I have not read any study that suggests that stenting a 70-80% stenosis  will lead to any lower danger of heart attack or death.
Rather the studies seem to indicate that the only superior benefit from the stent will be the alleviation of possible symptoms in a individual with stable angina.  So yes,  if he/she had bothersome symptoms they wanted to try to eliminate, then that would be reason enough to  do the stenting.  
As to the avoidiing the side effects of meds from doing the medical route,  such as statins etc,   that might be beneficial,  however with the stent,  they need to take other meds,  Plavix, etc,  which may introduce even more troubling side effects.

At some point it will be a personal choice,  I just didn't seen any clear benefit to stenting given the few facts we were able to read in the original post.
Perhaps the original poster will add other details to include symptoms that brought him into the doctor in the first place.   Plus age,  blood tests,  etc.

[ed34]

I'm assuming that they must have had symptoms to have gone through such scans? Also, the blockage is above 70% which makes it dangerous. Thirdly, I think it would be a better solution than to try and tolerate medications which can have bad side effects.

[Circa49]

ed34...   I'm curious as to your reasons for favoring a stent if you were in this persons situation..
They didn't mention any stable or unstable angina or any other reasons to choose a stent.

So why choose the stent instead of meds and lifestyle alterations
  Just wondering...

[ed34]

hardly severe at all, in fact it's pretty good. You could have the 70-80% stented but you could also manage it with medication. I would opt for stenting rather than going on meds.