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Chest tightness and pain, done angioplasty. Done CT scan. Guidance?

Dear Dr. I am a 66 year old heart pataient.I had gone through Angioplast in 2001 and three stents were installed by Dr.Rane and others.I reduced my weight from 85kg to 70 kg followe low fat diet and did excersice.For 11 years I did my normal work of site engineer.Last year only I reduced my excersice and lost little contro over diet with the result I started having problem while walking.I am getting chest tightmness slight pain and after I take rest it disapper.i got CT-Scan done report of which I am reproducing below.One Cardiologist suggests Angioplasty in LAD with a stent and other suggest low fat diet and excersice as it is a border case.When I am in my home and do naormal household work I donot get Angina.I am taking Novostat20,Clavix AS 150,K-ION,Metocard XL 50 and occassionaly Metrolong 2.6 when I go out for stroll.Please see report and give your opinion and if I have to go through Angioplasty where I should get it done in Mumbai(I stay at Vashi) and how much it will cost me. Jupiter Heart Scan Name of Patient: J.B.Singh Age/Sex : 66 years/M MDCT CORNORY ANGIOGRAM PROTOCOL: MDCT Cornory Angiography was performed on Somatom Sensation 64 slice(SIEMANS) CT scaner with 0.625 mm slice thickness after interavenous administration of on-ionic contrast agent.Retrospective 3D reconstruction of Data was performed to obtain volume rendered images.Mean heart rate during the examination was 59 beats per minute. OBSERVATIONS: Left main cornory artery is normal in course calibre and shows good contrast opacification.No ostial lesion is seen. Left anterior desecnding artery (LAD) is normal in course.Few mixed plaques are seen in proximal LAD before the stent causing moderate(approximately 50 to 60%) luminal narrowing A stent is seen in situ in LAD after the origin of D1 branchThere is good intrastent contrast opacification.LAD is type II vessel.. Diognal artery (D1) is seen.Calcified plaques are seen in proximal D1 causing mild(approximately 30 to 40% ) luminal narrowing. Non Dominant Circumflex artery (Cx) is normal ofcourse.A stent is seen in situ in proximal OM1. Intra stent hypodensities are noted in proximal segment of OM stent however there is good contrast opacification distal to stent. Dominant Right cornory artery (RCA) is normal in course.Multiple mixed plaques are seen in mid and distal RCA causing mild narrowing. Posterior descending (PDA) and posterolateral ventricular branches (PLV) are seen arising from the right cornory artery and appear unremarkable.Right cornory dominance is observed. Wall thining of left ventricular apex is seen. No abnormal valve calcification is seen. Pericardium and mediastinum appers unremarkable. Visuliszed lung parenchyma and pulmonary vasculature appers unremarkable. Visulized portions of right and left internal mammary arteries(RIMA & LIMA ) are normal. Dr.I am a retired person and will be thaknful for your guidance. My e-mail ID is YYYY@YYYY
Asked On : Mon, 22 Oct 2012
Answers:  1 Views:  81
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General & Family Physician 's  Response
Hello sir, thanks for providing an excellent details of your complaint. I would like to suggest you to be calm and analyse the situation carefully . You have already undergone angioplasty 10 years back and as per your history living a very disciplined life except for aberration recently and till now you were symptoms free. You experienced chest pain only while walking ? or while walking and doing little bit more than your regular household job ?. Needless to say i am assuming you don't have any habits ( smoking, drinking) as you have not mentioned those. If the amount of work combined don't give you discomfort/ pain then you can wait . The report of your CT scan shows development of new diseases but in very early days or old disease which have not progressed due to your disciplined life , however if you are symptomatic ( if you are having chest pain / chest heaviness/ breathlesness on minimal exertion or rest ) then i would consider the report to be significant for you. Lastly i would highly recommend an advice from a cardiothoracic surgeon as you already have undergone angioplasty previously .
Answered: Mon, 29 Oct 2012
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