Sign-in to Ask A Doctor - 24x7
OR
Sign in with GoogleGet your health question answered instantly from our pool of 18000+ doctors from over 80 specialties
Has Been Prescribed Stress Thalluim To Decide On Vascularization. Suffering From Arthritis Also. Family History Of CAD. Is Bypass Mandatory?
Hi! My mother aged 63 with history of diabetes & hypertension for p[ast 12 years underwent Executive checkup. Her ECG was abnormal and so was TMT which was highly positive for excised induced reversible Myocardial Ishemia. We consulted cardiologist who prescribed Angiography. The Result of Angiography are as under.
Left Main : Osteal plaque with 40 % stenosis
LAD : Minor Plaque
LCX : OM I is 100 % occluded, distal vessel fills through Collaterals.
RCA : Dominant, MID 100 % occluded. Renal Angio : Minor plaque.
We were advised Stress Thallium to decide nest course of action. On consulting our regular doc he asked us to consult his known Cardiologist, who recommended CT Angio. We did CT Angio and the results are as under.
Proximal RCA is thin in Calibre with Occlusion in Mid - RCA, Distal RCA & PDA are of thin Calibre
The LM Shows and ostial narrowing of Approx 25-30 %
The Distal LM Shows a Non - Stenotic calcified plaque which extends across the CX ostium. The OM I is not visualized suggestive of complete occlusion. The rest of CX & Ramus shows no significant stenosis.
The Proximial LAD and distal most LAD show eccentric calcified plaques causing trivial narrowing.
We were suggested Angioplasty but also told it might not be successful as getting it done in RCA is typical job. We decided to go for stress thallium to check the blood flow to decide further as don't want to take any chances. However all of sudden my mom developed serious arthritis which is serious. Her knee joints, both shoulders, wrists, ankles thighs are paining with inflammation in different parts and she is unable to move or even get up from bed. The physician has asked for blood test, i.e. Uric Acid, RA Factor, CPK, CBC.
We are worried, if this related to her double vessel disease? What should we do in this? Is stress thallium only way to decide on vascularization? What should be our next course of action? On one hand her cardic issue and now this? Please guide us? Is bypass necessary? Or even Angioplasty is helpful? What about this artritis?
Our family has history of CAD, specially my mothers side...this increases our worry. Please suggest
Left Main : Osteal plaque with 40 % stenosis
LAD : Minor Plaque
LCX : OM I is 100 % occluded, distal vessel fills through Collaterals.
RCA : Dominant, MID 100 % occluded. Renal Angio : Minor plaque.
We were advised Stress Thallium to decide nest course of action. On consulting our regular doc he asked us to consult his known Cardiologist, who recommended CT Angio. We did CT Angio and the results are as under.
Proximal RCA is thin in Calibre with Occlusion in Mid - RCA, Distal RCA & PDA are of thin Calibre
The LM Shows and ostial narrowing of Approx 25-30 %
The Distal LM Shows a Non - Stenotic calcified plaque which extends across the CX ostium. The OM I is not visualized suggestive of complete occlusion. The rest of CX & Ramus shows no significant stenosis.
The Proximial LAD and distal most LAD show eccentric calcified plaques causing trivial narrowing.
We were suggested Angioplasty but also told it might not be successful as getting it done in RCA is typical job. We decided to go for stress thallium to check the blood flow to decide further as don't want to take any chances. However all of sudden my mom developed serious arthritis which is serious. Her knee joints, both shoulders, wrists, ankles thighs are paining with inflammation in different parts and she is unable to move or even get up from bed. The physician has asked for blood test, i.e. Uric Acid, RA Factor, CPK, CBC.
We are worried, if this related to her double vessel disease? What should we do in this? Is stress thallium only way to decide on vascularization? What should be our next course of action? On one hand her cardic issue and now this? Please guide us? Is bypass necessary? Or even Angioplasty is helpful? What about this artritis?
Our family has history of CAD, specially my mothers side...this increases our worry. Please suggest
Tue, 28 May 2013
Dear Sir
Thanks for your query to us.
1. No, no one will take her up for revascularization with this arthritis which is not related to her heart condition. Neither it will be prudent to subject her to thallium right now. First treat her arthritis by consulting a rheumatologist.
2. Stress Thallium will tell you the significance of her LMCA lesion, which is the crucial point. If her LAD territory is ischemic (i.e. LMCA lesion is significant), then Bypass is best and perhaps only option. If her LAD territory comes out to non-ischemic on thallium, then scenario will change altogether. She may be taken up for angioplasty or only medical therapy depending upon certain factors.
Hope this helps.
Sincerely
Sukhvinder singh
Thanks for your query to us.
1. No, no one will take her up for revascularization with this arthritis which is not related to her heart condition. Neither it will be prudent to subject her to thallium right now. First treat her arthritis by consulting a rheumatologist.
2. Stress Thallium will tell you the significance of her LMCA lesion, which is the crucial point. If her LAD territory is ischemic (i.e. LMCA lesion is significant), then Bypass is best and perhaps only option. If her LAD territory comes out to non-ischemic on thallium, then scenario will change altogether. She may be taken up for angioplasty or only medical therapy depending upon certain factors.
Hope this helps.
Sincerely
Sukhvinder singh
I find this answer helpful
1 Doctor agrees with this answer
Disclaimer: These answers are for your information only and not intended to replace your relationship with your treating physician.
This is a short, free answer.
For a more detailed, immediate answer, try our premium service
[Sample answer]
Related questions you may be interested in
Recent questions on Left coronary artery
Loading Online Doctors....