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Had coronary Ct angiogram. Showed 40-50% luminal narrowing in left diagonal branch. Treatment?

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I recently had a coronary Ct angiogram because of family history. He showed a 40-50% luminal narrowing in the left diagonal branch. Does this usually require a stent or how is it treated. I aM 61 with no symptoms there is also a 30-40% narrowing in the left anterior descending artery
Posted Sun, 22 Sep 2013 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 22 minutes later
Brief Answer:
No stent required. see details.....

Detailed Answer:
Respected Madam
1. The clinically recommended and accepted practice is to put a stent only if the lesion shows a diameter narrowing of more than 70% in any artery except for "left main coronary artery" (LMCA). The limit for LMCA is any lesion more than 50%.
2. A lesion less than 50% is not considered even in the definition of angiographically proven epicardial coronary artery disease.
3. If a lesion is more than 50% but less than 70%, it is normally treated for aspirin and statins for prevention of future events. Although such lesions do not cause any symptoms themselves.
4. Beside we look into usual risk factors for coronary artery disease & assess the risk for future cardiac events and advise preventive measures. This is true for lesions < 50% also. The risk factors include smoking, diabetes, high blood pressure, high cholesterol, psycho-social stress, obesity, physical inactivity etc.
Hope this clarifies the issue. Feel free to discuss further.
Sukhvinder Singh
Above answer was peer-reviewed by
Follow-up: Had coronary Ct angiogram. Showed 40-50% luminal narrowing in left diagonal branch. Treatment? 7 minutes later
if there is plaque in the arteries at 40-50% is there a possibility that it an break off and cause a blockage causing a heart attack
Answered by Dr. Sukhvinder Singh 9 minutes later
Brief Answer:
Yes this is possible but .........

Detailed Answer:
Respected Ma'm
1. The plaques which burst off and cause heart attack are less than 70% in ~85% of the patients. Only ~15% of patients who develop a heart attack have a plaque with >70% stenosis, at that site, prior to heart attack. Which of these sub-critical plaques will break-off is not known and can not be predicted by any test.
2. Hence, the answer to your query is YES. A plaque with 40-50% stenosis can break off and cause a blockage leading to heart attack. But The consensus is not to treat them with angioplasty or stent. It is not found to be useful. So practically if you are not having symptoms, it is not of any use to find out how many sub-critical (<70%) plaques you have. Because management will not alter by knowing there number. In any case, you have to take precautions to prevent a future attack. The measures will include life style modifications and at times drug therapy.
Hope this settles the issue. Still feel free to discuss further, if you have anything in mind. I will be glad to answer.
Sukhvinder Singh
Above answer was peer-reviewed by
Follow-up: Had coronary Ct angiogram. Showed 40-50% luminal narrowing in left diagonal branch. Treatment? 8 minutes later
Thank you very much for you imput. My cardiologist is on holidays so I have been quite anxious. I guess this plaque has been there for some time and the answer is not it get it to increase hence the medication and lifestyle changes.
My concerns were that if I went away on holiday I did not feel that something was going to happen in another country. Do you think I am a time bomb waiting to go off!!!
Answered by Dr. Sukhvinder Singh 6 minutes later
Brief Answer:
nope, but do not worry

Detailed Answer:
Respected Ma'm
1. No, It is not so that you are sitting on a time bomb. Do not be too anxious or worried. Whatever I have told you is a standard internationally accepted practice. None and no test can predict the occurrence of heart attack in a given individual, whatever may be the extent of obstruction.
2. Do not be worried unnecessarily, because stress itself is a risk factor for plaque rupture. Just adopt the required life style modifications and take drugs if your cardiologist thinks so (after looking at your complete work-up). You can not do more than this much and must not be panicky on this issue.
Have a healthy and happy life.
Sukhvinder Singh
Above answer was peer-reviewed by
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