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Does High Left Main Score And High LAD Suggest Angioplasty?

Posted on Mon, 9 Dec 2013

Question: CARDIOLOGIST QUESTION SUMMARY INFO: Coronary Artery Calcium Score is 197. Left Main artery score 88; Right Coronary 16; Left Anterior Descending 96. Rest of coronary arteries 0. White MaleAge 69. BMI 24.2, Lipids consistently low and on target: Col 155, LDL 75, Trig 101m, HDL 70. Stress test: full pass. Echo shows mild stenosis of Aortic opening. BP 125-135 /60-75. Resting pulse 45-50 BPM, No medical symptoms known (no diabetes, cancer, asthma, etc.), many minor muscle and joint issues from training. Never smoked, moderate wine. Engage in regular ( 4x per week), serious, heavy cardio with team training for masters competitive swimming with no obvious heart or breathing symptoms other than workout fatigue similar to younger teammates. Pulse is up to 155 on various repeat swims during practice. Diet focus on beans and legumes but not perfect. 6 - 7 hours sleep most nights. QUESTIONS: Obviously CAC is indicator of CAD and should be taken seriously. Does high Left Main score and high LAD suggest angioplasty or more? Are there any more lifestyle/nutrition changes that could help, given all that I am currently doing? What would Stress Echo or Stress with Nuclear do to clarify the situation, especially with respect to continuing high intensity training? Other guidance?

Answered by Dr. Benard Shehu (1 hour later)

Brief Answer: Please refer to the following suggestions... Detailed Answer: Hi, The coronary scan shows data on atherosclerotic disease of the coronaries for which you should do angiography (for proper evaluation of atherosclerosis). If there is any problem, the best things to do based on guidelines of AHA/ACC is to do CABG and correction of aortic valvula through protesis. Before going for angiography, you should perform first stress ECHO test or stress-scintigraphy. You should go on with the lifestyle and diet changes you are currently following. Can do light to moderate exercise without overloading. Although being asymptomatic, once you notice any symptoms (chest pain, difficulty in breathing, faint, etc.) should go to ER immediately. Hope it answered to your inquiry! If you have more questions, do not hesitate to write me back! Dr.Benard

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Benard Shehu (8 hours later)

Thank you. Interesting. Of course I am doing the stress nuclear. To refine my question: What does the Main Coronary Artery CAC score of 88 mean by itself in practical and quantitative terms? e.g. What doe this suggest in terms of degree of stenosis, or blockage in that artery; also risk of a clot from plaque breaking free in this artery and creating heart event. Is it normal to see CAC like in this this artery without other (except for LAD)? Ditto above for CAC 96 in LAD; and for the combination of the CAC the two in the same branch Separately, what part of my text describing my exercise fits your reference to "moderate exercise ! ? " Thanks

Answered by Dr. Benard Shehu (9 hours later)

Brief Answer: Please refer to the answer below... Detailed Answer: Hi, Thank you for writing back. Your overall coronary CAC score is 194, which means that you have more than double the chances to develop heart events for the next 10 years. (The score derived from two lessions one in the CAC and the other in LAD but the predictive value derived from the total score.) To evaluate the level of stenosis and the right level of severity of such damages, the most appropriate tests include Ct-coronary angiography and angiography. The scan you already ran serves as predictor of the risk for heart events in the next 10 years ahead. The scan results would not show the risk of the plaques and/or which of them will disrupt. With regards to the "moderate exercise", that is individual. In other words, must know or understand which exercise gives you problems (especially pain). Once you start feeling pain, that's the highest limit for you to prevent heart events. Hope it answered your inquiries! If you have more questions, do not hesitate to contact me again! Dr.Benard

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Benard Shehu (17 hours later)

Are you saying that there is NO predictive and NO diagnostic information that can be derived from the individual Main Coronary Artery and the LAD CAC scores.? I am not doing moderate exercise. By all outside measures and by my own exertion, sustained high BP, etc., it is extremely strenuous for 1.5 hours three times a week., plus competitions. No symptoms but fatigue, like my fellow teammates. Last Question Thanks

Answered by Dr. Benard Shehu (11 hours later)

Brief Answer: Please follow the suggestions below... Detailed Answer: Hi my dear, Let me explain again: The CAC scores determine the overall risk for any coronary event for the next 10 years. The scores for the left main coronary artery and LAD in particular indicate the location of the atherosclerotic plaques, but not the severity and the risk of this plaques. This should be confirmed by angiography or ct-angiography. Your data indicate moderate aortal stenosis and the location of the atherosclerotic plaques are in the left Main. So, I'd advise to continue restricted exercise until you perform stress scintigraphy. Dr. Benard Shehu

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Benard Shehu (2 hours later)

OK. You have said individual artery CAC scores are is just indication of location, not individual artery severity. I doubt that they are that empty of information, but will hear from my cardiologist. Of course angiography; we will be doing all that, but I was asking for general information in advance, though of course not prescriptive. Based on what you have said, I am not sure you are very much engaged in thinking on this, but just stating the book. Clearly I have said that I am doing extremely strenuous exercise, and you twice have come back to say "continue" moderate or restricted exercise. That sound like poor advice or communication, since you probably should have said "I strongly advise you to restrict your currently strenuous exercise to more moderate levels." Thanks for your efforts.

Answered by Dr. Benard Shehu (1 hour later)

Brief Answer: Wish you health... Detailed Answer: Hi again H.cole81, Thank you for writing back. The medical terms are difficult to understand. However, as you are going to discuss with your cardiologist, please send him/her my regards and my earlier suggestions. All the best! Wish you health! Dr.Benard

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar