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Blockage in LAD, have dizziness, lightheadedness, backpain. Family history of CAD. Suggestions?

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Practicing since : 1998
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i have 40-50% blockage in LAD with no muscle damage. My mother and paternal grandmother died from CAD, as well as my uncle and one of his sons. I have high BP and cholesterol. I have symptoms - dizziness, lightheadedness, pain in back that radiates at times. Why wait until 70%?
Posted Sun, 26 May 2013 in Heart Attack
Answered by Dr. Sukhvinder Singh 1 hour later

Thanks for writing to us.

Before I answer your main question, I would like to tell you something which is standard.

1. An intervention/ operation / treatment is always done either to improve symptoms or to decrease future rate of XXXXXXX events which will result in prolongation of life. Angioplasty (opening of blocked artery by ballooning alone or with stent placement) has certain valid indications as per standard guidelines and should be performed only in those conditions. Namely these are an acute cardiac event (minor or major heart attack associated with at least 70% blockade of a significant sized vessel {50% for left main artery}or patients with stable angina who can not be managed with standard drug therapy and has debilitating symptoms and has more than 70% blockade in vessel ).

2. Now why it is 70%; first thing is that it is proven by experimental studies and clinical experience that blockade less than 70% cannot cause angina or anginal symptoms. Hence the symptoms or problems of patient with blockade <70% are not due to this lesion and therefore will not be cured by treating this lesion. Second, there will not be any prevention of future heart attacks or death by doing an angioplasty in these lesions (less than 70%).

Moreover, even if the lesion is more than 70% and patient does not have acute heart attack (and has only angina on exertion), doing an angioplasty will not decrease future incidence of heart attack and future risk of death. it only helps in ameliorating the symptom of patient.

I hope I cleared your doubt. Feel free to discuss further.

sukhvinder XXXXXXX
Above answer was peer-reviewed by
Follow-up: Blockage in LAD, have dizziness, lightheadedness, backpain. Family history of CAD. Suggestions? 22 hours later
So I assume my cardiologist will likely recommend dietary and lifestyle changes, maybe nitro for the symptoms and what else should I expect in terms of treatment. I really hate to be on a lot of meds.
Answered by Dr. Sukhvinder Singh 16 minutes later
Dear Madam
1. A blockade less that 70% will not require nitroglycerine.
2. If the blockade is surely more than 50%, a statin and an anti-platelet drug will be given (I will not discuss names).
3. If blockade is <50%, then he will look at overall risk for future cardiovascular events (heart attack/stroke) and then decide if you really need a drug or not.
4. Yes, life style and dietary modifications will always be on the cards and you must follow them.
I hope I clarified the issue. Feel free to ask if there is anything more.
sukhvinder XXXXXXX
Above answer was peer-reviewed by
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