Angiogram Options

[agapeman]

I saw a cardiologist last week and he has me scheduled for an angiogram next week due to abnormalities on my nuclear stress test and signs of possible blockage.  I also have a high angaston score of 957 predominately in the LAC.  He seemed to be rather laid back about how big of a deal this could be because I'm not having angina or shortness of breath.   I was prepared for the appointment but later wondered why I didn't ask him if I should get a CTA which is non-invasive since he just wants to take a better look. Is a CTA (64 slice) a good option?  They do have the equipment on site.  I called his nurse and she is going to have him get back with me any opinions out there?  Thanks

[ed34]

You are certainly one of the lucky ones to have opened collaterals and save your heart. One thing I would ask is regarding the 50% blockage. Obviously either the left circumflex or the right artery is feeding your LAD. If the 50% blockage is in the artery feeding your LAD, then I would seriously consider getting this stented and made as wide as possible. Think about it, if the source for the LAD blocks, you will have the complete left side of the heart shut down. Not a good thing. My left circumflex is the lifeline for my LAD and I ensure this is completely open all the way down.

[Flycaster305]

I'd say this is very, very good news.  I've had ten stents inserted and had bypass surgery, but one of those unlucky ones with poor collateral formation.  I'd take the drugs, and exercise, plus follow a heart-healthy diet.  The 50% blockage will probably need attention in the future, I'd ask for a yearly nuclear stress test.  You will get a lot of advice to take 'natural' medications and off-the-wall diets, at least I have.  After 12 years of heart disease I'm still standing by taking the drugs recommended by the medical community.  Ed34 will probably agree, we both wandered from conventional medication and we both really paid a big price for our detour.
Keep us informed.

[agapeman]

Update: I just got home from an angiogram, I was too medicated to remember much but a nurse friend of mine  spoke with the Dr.  and learned I have a 100% blocked LAD but the good news is that I have vigerious blood flow due to extremely good collaterals that have developed. Doc was a bit amazed.  He said no further intervention at this time but continued meds and diet and exercise program.  I'm still in a bit of a fog but happy that he didn't even stent me in another artery that had around 50% stenosis (back side artery).  I will meet with him again in a few weeks and learn more.  Any insight to what this news means?  Sounds encouraging to me.  Thanks for any replies.

[agapeman]

I talked to my Cardiologist this morning and he explained that my stress test results were very clear that I had a restriction that he needed to look at by an angiogram and most likely fix with a stent.  So any other testing wold be redundant. So I am going in for the angiogram next week. I just wanted to say thanks to all who replied, these forums help a person like me learn and understand what to expect.

[Occupant]

Judging by your Agatston Score, you already had a CT scan which has an absorbtion rate of 40 to 100 mGy and now you want to double that by having a CT-A - a typical chest X-ray is 0.01 to 0.15 mGy, think about it.

[Jerry_NJ]

My cardiologist said the angiogram is the "gold standard" for checking for blockage.  I've been through two myself, no big deal.

I too have problems "passing" a nuclear stress test, but the last one I had a few months back went fine.

[ed34]

Put it this way, most Cardiologists prefer to examine the arteries with an angiogram and while inside you, if they see a big problem, there is a good chance they can resolve it at the same time. If you have a CTA and then an Angiogram, you double the radiation, on top of the Nuclear scan you've already had.