My Friend Is 59 Years Old. He Was Diagnosed To

Posted on Fri, 9 Oct 2020

Question: My friend is 59 years old. He was diagnosed to have a heart issue.
He took some initial reports.

Then he took a CT angiogram.

If you accept this question, I do not want layman answer. I want you to carefully analyze the information available.

Based on the information available, I need to know a detailed answer and a plan.

If you are busy, please do not try to answer in brief manner. i.e, already what we know.

Answered by Dr. Dr Sameer Maheshwari (1 hour later)

Brief Answer:
Please find detailed answer.

Detailed Answer:
Hi,
Welcome.
This is Dr Sameer Maheshwari, cardiologist.
I went through the attached CT angiogram which shows you have some amount of blockage mainly in the Left sided coronary artery (LAD).
Firstly I would like to know what symptoms do you have??

For blockage in CT angiography which are below or equal to 50% we generally advise our patients for medical management i.e. we put him on blood thinner. For significant blockage we ask them to go for invasive coronary angiography which is the gold standard to quantity the blockage as CT angiography percentage of blockage is not exact.

So please let me know the symptoms, whether you are a diabetic or a smoker?
Considering only the CT angiography report I would put you on medical management on a combination of Aspirin 75mg and Atorvastatin 20mg.
Thanks and regards

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

Follow up: Dr. Dr Sameer Maheshwari (35 minutes later)

Dear Doctor

He doesn't have diabetes. His lipid readings are normal as per the report. He id not a smoker.

Currently, what is the blockage LAD ?

Currently, he is crestor 20 mg.

He has not been prescribed aspirin.

He has no angina although he felt weakness in left leg.

Current cardio surgeon ruled out angioplasty.

What is your second opinion ?

Thanks

Answered by Dr. Dr Sameer Maheshwari (1 hour later)

Brief Answer:
Please find Detailed answer

Detailed Answer:
Hi,
Welcome back.
As per the CT angiography report maximum blockage is at mid part of one of the arteries (LAD - Left anterior descending) which is around 50%.
Actually CT angiography has 100% negative predictive value which means if it shows no blockage than 100% sure that their is no blockage, but the positive predictive value is not 100% which means if blockage is 50% it could be 40% or 60%.
So if it shows significant blockage which is defined as blockage >or equal to 70% than invasive coronary angiography is required to exactly quantify the blockage.
Otherwise we just advise for medical management.

Its good to know that he does not have any symptom (chest heaviness) and he is not a diabetic or a smoker.
Your doctor has rightly said that he does not need any further invasive tests (angiogram) and he is rightly on Crestor (Rosuvastatin).
For such patients we also advise to have 75mg of Aspirin which is a standard regimen for plaque stabilization and you should discuss it with your doctor. Another variety of medication which is important for such patient is beta blocker and you should discuss that too.

So to summarize-
He just should be put on medical management including
1) Statin - Which he is already taking (Crestor)
2) Aspirin - 75mg once a day
3) +- Beta blocker- according to BP and heart rate.

I hope this helps
Thanks and regards

Note: For further queries related to coronary artery disease and prevention, click here.

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