coronary arteries blockage-Angiography

[nagrajjain]

I am advised bypass surgery with four grafts. After six years I have second heart attack.I was leading normal life and all of a sudden I had both attacks.With treatment I am normal now.My physical abilities are not affected.Why should I then go for bypass. Doctor says that I can have another attack therefore bypass is necessary. But I have heard that even after bypass people get attacks then why go for?

Cutting chaste bone,pearsing heart arteries and arota,taking graft from leg all of these things are equally dangerous.They may affect my life style adversely. Should normalmperson go for bypass and take risk.

[nagrajjain]

My LVEF is ok in the sense my heart can supply blood to body as per requirement from body at rest to body at required exersion. If blocked coronary arteries can not supply the blood to heart then from where heart is getting blood supply. My level of exercise looking into my age is ok .I do not have any sort of heart problem while exercising. Mental-stress is my killer as i know. I am type 'A'  personality. Mental stress is my enemy nad not physical stress. Both the attacks were preceeded by mental stress.
Thank you for open discussions and the interest you have shown. I will try to keep you informed future developments as they come in.Their are areas not even clear to doctors in the matter.

[ed34]

I understand what you are saying, and the reasons why you are saying it, but I'm not sure what you mean by your LVEF being something to go by. For example, my LVEF is 70% yet I struggle to walk up just one flight of stairs. Going by your idea, I should be able to run the London marathon with no problems. On exertion, the lower part of my left ventricle doesn't get quite enough Oxygen, but is fine when relaxed. Due to no tissue damage, my LVEF should remain at 70% and medication helps hide many of the symptoms.
If they are not sure about collateral development, then they should organise a nuclear scan to get a clearer picture. I am confused about your collateral development, if that is the case, because usually the left side will feed the right, or the right will feed into the left side. From your results, it clearly shows both sides have serious restrictions and so I have to wonder where the collateral supply is actually coming from. When a person is diagnosed early with cancer, there may be no symptoms, it could be caught through a screening process. If the patient says they will have no treatment because they feel fine, but they are aware there is a disease there, are they making the correct decision?
Of course, I respect your decision, it's your body but if you are going to rely on medication then I would make some serious alterations to your lifestyle to slow the disease. Blood pressure and cholesterol level checks, healthy diet, frequent exercise, learn to handle stress and remove as much as possible from your life. With those changes and medication, you never know, you may prevent the disease getting any worse. I really wish you all the best and hope everything turns out well for you.

[nagrajjain]

Even now I climb seven stories of building. I can walk with ease for one hour.I am on medication now. With such results of angiograph I wonder how can I do this.This means my LVEF must be more than 50 percent.Even after one day of attack it was 40 percent. I am told there is all probability of colateral blood flow to have established.Pit fall of angiography is that it does not speak about blood flow in arteries having less than one mm diameter. Colateral blood flow is at that level.
I am 71 years old. As it is no guarantee and doctor does not guarantee even after bypass then why to go for with such a risk.In case of emergency I can understand but not otherwise. Thank you for your openion.

[ed34]

With such large restrictions, and so many, I personally would heed the advice of the cardiologist and have bypass surgery. Have you made considerable life style changes to slow the disease and has the progression been slowed according to angiograms?  I can only give my opinion here and with such a lot of disease, especially in the LAD, I would have surgery.
If one of those restrictions ruptures, you could be out of luck.

[nagrajjain]

My coronary angio report
1 The proximal LAD has a 90% long segment lesion followed by a 80% short segment lesion. The mid LAD has a 60% long segment lesion.D1 and D2 are diseased.
The ostialLCx has a 60% eccentriclesion. The mid LCx has a 80% eccentric lesion.
The proximal RCA has a 90% short segment lesion followed by a 90% long segment lesion in its mid segment. The distal RCA is diseased.Thus three vessle coronary artery disease.
2 Recent IWMI
3 Mild LV dysfunction

I too feel medication should be the first option. When twice lucky I may be lucky third time too.

[ed34]

You must have received treatment very quickly to prevent damage from two heart attacks. I assume these were clots and were treated with drugs or dissolved on their own. Either existing plaque ruptured and released underlying clotting material or, some plaque broke free causing a clot to form. Either way, it sounds like you have got away with it lightly but you need to ask if you will be so lucky the next time.
You are correct with regards to bypass surgery, you can still get heart attacks because the disease is not actually removed. The idea of bypass surgery is to channel more blood to deficit areas and make life easier for the heart. Bypass surgery is not a cure for disease. You say you are feeling completely normal, but normally after heart attacks you are put onto beta blockers, which keep the heart relaxed. IF this is the case and you stop the medication, then you may not feel as good as you think.
Can you give a bit more detail as to why your Cardiologist believes bypass is the best option, such as which vessels are restricted, which location in the vessels and the percentage of the restrictions? I am sure that if a patient feels no symptoms and Ischeamia hasn't been observed in the heart tissue, then bypass would not be suggested. If a patient feels normal and tissue is showing a small amount of Ischeamia, or none but the blockages are quite extensive, then medication is the usual first option.