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Had Heart Attack. Angiography Showed Triple Vessel Disease. What Does This Suggest?

Posted on Wed, 3 Jul 2013

Question: My father had an heart attack and did not know it. He came to know after 4 days when he visited hospital for checkup. The doctors conducted a Angiography and attached is the result. Please give us your opinion on this matter. Below is text of the report and attached is softcopy.

Findings
LMCA – Normal and bifurcated into LAD and LCX
LAD – Is Type III and is good sized and calcified vessel, Proximal LAD has total occlusion, mild & distal LAD not seen.
LCX – Co-Dominant system, Proximal LCX has 70-80% lesion. Mid and distal LCX has non flow limiting lesion.
RCA – Dominant system & calcified vessel. Proximal RCA is normal. Mid RCA has 80% lesion, distal RCA has non flow limiting lesion.
LV Angio – Not done
Impression – CAD – Triple Vessel Disease

Answered by Dr. Akhilesh Dubey (1 hour later)

Hi,
Thanks for sharing your concerns,
I have seen attached all reports and following are my comments.

1) He has significant obstructive coronary blocks in multiple arteries.

2) Looking to his reports revascularization is strongly recommended by CABG (Coronary artery bypass graft) is preferred over Angioplasty in such cases.

3) Is he having other risk factors like High blood pressure, Diabetes, High cholesterol level and smoking?

4) In the meantime he must take optimal medical therapy statin, aspirin, Beta Blocker, and Nitrates.

5) Discuss with Cardiologist and cardiothoracic surgeon and then take decision.

Hope I have addressed all your concerns, if you have any doubt please ask, I will be happy to help.
Take care.

Regards.
Dr. Akhilesh Dubey M.D.

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

Follow up: Dr. Akhilesh Dubey (20 minutes later)

Doctor from KLE hospital Belgaum said there are 3 blockage. 2 of them are 70 to 80% and 1 is 100%. The doctor is suggesting Angioplasty on all 3 blockage. The doctor said that the 100% blockage is the place where heart attack had come.

Is stent needed to put in all 3 places?
Is it ok to put Indian stent ?
Is CABG the only option?
Does he urgently need to undergo surgery or can wait?

I have attached another report, please reveiw. He has long history of chewing tabacco, doesnot have diabetes. He has history of high blood pressure.

Answered by Dr. Akhilesh Dubey (24 minutes later)

Hi,
Thanks for your Input,

It is true that the 100% blocked artery is the one which caused heart attack.
It is possible to put 2 or 3 stents after angioplasty.

Urgency of the procedure depends on if he is getting anginal pain or has restricted activity otherwise he can wait for some time with all medications. When stents are used it is best to go for best available they are DES (Drug eluting stents) and cost needs to be considered.

CABG is preferred in multi vessels disease, although angioplasty is possible.
I have seen the report attached Enzymes are raised due to his heart problem.
He should stop using tobacco completely and take treatment regularly.

Hope this helps, If you have any further query please let me know, I will be available for clarification.

Regards.
Dr.Akhilesh Dubey M.D.

Note: For further follow-up it is advisable to consult an emergency medicine specialist. Click here.

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