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Angiogram showed 90% stenosis. Suggested bypass. How serious is it? Trying EECP. Guide?

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before 10 days, my father had gone angiogram. found 90% stenosis , 80% stenosis and 60% stenosis. doctor advised to go for immd it really need to go for bypass immd.How serious is it ? We are trying for EECP. What do u recommend ?
Posted Sun, 28 Jul 2013 in General Health
Answered by Dr. Irshad H Naqvi 3 hours later
Hi Dear,

Welcome to the board of Health Care Magic.

As the report of angiogram says that there are some vessels who are almost going to be totally occluded. These things are little worry some for the future of your father. Any exertion or stress (mental or Physical) may lead to further anoxia of the heart muscle and in consequences of this there are possibility of Myocardial Infarction in future.

Good thing is that the Left Ventricular systolic function is normal and LVEF is 60% means at this moment there is no damage to heart muscles and the left ventricle is working perfectly.

Hence if the occluded vessels are opened any way through bypass or putting the stent will decrease the possibilities of MI which in turn may lead to health future to your father.

Hope the query is answered.

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Follow-up: Angiogram showed 90% stenosis. Suggested bypass. How serious is it? Trying EECP. Guide? 5 hours later
DR sir,

I want to know how many blocks are there . Angiogram doctor had inf that there are 3 multiple blocks in 1 value and other 2 are fine whreas cardiologist says all three valves have complete blocks. whick is correct. Also our cardiologist had inf that stent or angioplast is not possible and only bypass should be done. Is it true. Also we dont want to do inavasive treatment. We are trying for EECP. Weather it will be helpful.
Answered by Dr. Irshad H Naqvi 7 hours later
Dear friend,

I would like to explain the report of angiogram.
1. Distal Right coronary artery is almost at verge of total blockage.
2. Proximal LAD (Left Anterior Descending artery) is totally occluded.
3. LCX (Left circumflex artery) is 90% blocked.
4. LPDA (Left Pulmonary Descending Artery) has also started blocking.
5. One of the Marginal arteries there is about 80% occlusion.
6. One of the Diagonal artery is about 60 % blocked.

Over all there is good amount of occlusions, along with the preserved heart functions and muscles (undamaged heart). So Your father qualify as a candidate for invasive procedure. This is the ideal time for any invasive procedure before the heart muscles gets damaged/infarcts because of increasing occlusion and recurrent anoxia. Anoxia (less oxygen supply) is the reason for the weakening and infarction of myocardium.
Stenting is many times not successful/difficult in multiple blockages.

It appears that invasive procedures are many times associated with some risk; but usually there are minimal chances of untoward results (provided your father is in good general conditions and free of other problems).

Regarding your interest in EECP (Enhanced External Counter Pulsation). I can imagine keeping myself in your situation that you are thinking in terms of avoiding any sort of risk associated with invasive procedure. Yes, you are right; but these alternative method of providing health care are many times not well established /approved by the medical institutions in terms of the providing the health care in toto. There is also associated risk of damaging the Heart muscle during the time lapsed and experimenting the alternative procedure.
EECP-The increased blood flow is delivered to your heart at the precise moment by the force full pumping of the blood from limbs to the Heart . We fear that if there is any aneurysm (bulging of the weakened blood vessel) in the aorta or any where in the coronary artery it may lead to rupture the blood vessel and that may be disastrous to the patient.

So I am not in favor of this type of treatment. Now I hope you will take the decision with more judicious manner. Let me know if you need clarifications.


Above answer was peer-reviewed by
Follow-up: Angiogram showed 90% stenosis. Suggested bypass. How serious is it? Trying EECP. Guide? 2 hours later
Dear Dr,

Thanks for your feedback. My last question. Is that we can go for bypass treatment after 2 months . since we need to be get prepared ( by physical and financial). Is that report is so serious that it should be done immd in next few days ? Ur kind reply will help us in many ways.
Answered by Dr. Irshad H Naqvi 7 hours later
Hi again,

Status of the myocardial function is perfectly normal.

We can wait till you are fully prepared. You can advice your father for minimal exertion so that there is not much stress is put on myocardium. In the mean time he should be on some medication like ecospirin, vasidilators etc as advised by your cardiologist.

Hope your query is answered.

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