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Had a MI initially presenting chest pain, unconsciousness, troponin positive, did angiogram. Interpret results?

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Cardiologist, Interventional
Practicing since : 1996
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My father had a MI initially presenting chest pain, loss of conciousness, fits and then recovered
He admitted to hospital and troponin was positive. They did an angiogram and the results are as follows

Four dominant vessel system
Left main normal following distal bifurcation LAD type 3 vessell with distal LAD having discrete 70% stenosis after 2nd diagonal
Diagonal and septal perforator normal
LCX CO-DOMINANT LARGER CALIBER DIFFUSELY ECTATIC VESSEL
om1 small caliber-70% stenosis
OM2 HAS PROXIMAL DISCRETE ECCENTRIC 60-70% STENOSIS
distal cx normal
CX-PDA HAS A DISCRETE ECCENTRIC PROXIMAL 50% STENOSIS
RCA CO-DOMINANT WITH OSTIAL DISCRETE 70% STENOSIS
REST NORMAL

4 VESSEL DOMINANT SYSTEM
ECTATIC VESSEL 3 VESSEL CAD

HIS ECG AND TROPONIN RETURNED BACK NORMAL AND HE WAS DISCHARGED ON MEDICINES WITH ADVICE OF ELECTIVE PTCA WITH STENTING OF 2 VESSELS IN 3 MONTHS

HE HAS NO OTHER RISK FACTOR HISTORY OR PREVIOUS EPISODES OTHER THAN COPD
HE IS AGED 73

IS THE COURSE BEING FOLLOWED OK
Posted Wed, 18 Apr 2012 in Hypertension and Heart Disease
 
 
Answered by Dr. Raja Sekhar Varma 11 hours later
Hello,
Thank you for your query.

As per the details that you have provided, your father has had an Acute Coronary Syndrome with positive troponin and ECG changes. Coronary angiogram has shown significant distal LAD stenosis, borderline significant OM2 proximal stenosis and significant ostial RCA stenosis.

Though it is difficult to comment without actually seeing the angiogram pictures, it is clear that at least the LAD and the RCA need PTCA/stenting. Since the OM2 lesion is of borderline significance, a decision on PTCA/stenting to that lesion would depend on the size of the OM2 branch, the exact degree of stenosis, the area subtended by the branch, and if possible, Fractional Flow Reserve calculation across the lesion by means of a pressure wire. If the lesion is deemed to be important, it might need PTCA too. Otherwise, it can be managed medically. However, a pressure wire and FFR measurement is not available in many centres.

The other blockages mentioned do not appear to be significant hemodynamically and probaby can be managed with medicines.

The timing of the procedure depends on the severity of the attack, the recovery from the acute phase, the presence of persistent symptoms and the protocols being followed in that particular institution. The ideal time for the procedure would be the period when benefits remain high and risks remain low.

Some institutions also do a nuclear imaging/dobutamine stress echo to determine the amount of viable, ischemic myocardium. If the entire area supplied by a blocked artery is scar tissue with irrecoverable damage, then there is no point in doing angioplasty to that vessel. Angioplasty can then be limited to those lesions which subserve viable, ischemic myocardium and opening of which will definitely prove beneficial.

Though there are multiple blocks, the nature, degree and location of the blocks are such that PTCA is a better option rather than bypass surgery. The age of 73 years and the presence of COPD also would mean that PTCA will be less riskier.

I hope this answers your query. Feel free to get back to me for any further clarifications.

With regards,
Dr RS Varma
Above answer was peer-reviewed by
 
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