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Diabetes and hypertensive. Getting chest pain, nausea and breathlessness. CT angiogram done. Suggestion?

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Cardiologist, Interventional
Practicing since : 1998
Answered : 424 Questions
My Father age 66 years is a diabetic type II patient from past 6-7 years .Also a hypertension (high blood pressure) patient from past 10 years.He is taking his medicine regularly for both the problems.Recently he was facing problems of breathlessness with chest heaviness on climbing 25 stairs and his excertion relieved with rest.
historically he had no giddiness, chest pain ,nausea,MI or stroke.Also he is regular in health checkups (in every one year to six months).

“On september last year 2012 he had undergone CT angiography which concludes following results (Ct angigraphy was performed on Siemens Defination flash scanner using slice Collimation of 2*128*0.6 mm with injection of 75 ml of non-ionic contrast media@ 6.0 ml/sec.Images were reconstructed in 0.75mm slice thickness.Additionally curved MPR were obtained using circulation software along with VRT.The study was preceded with a prospective calcium scoring.)
- significantly increased calcium scoring of 550.
-The left main coronary artery is normal.
-Soft plaque with mild stenosis (30%) in mid RCA.Proximal & distal RCA is normal.
-There is a long segment ,missed plaque with significant stenosis (>70-80%) in mid LAD seen.distal LAD is normal.
-moderate stenosis (30-40%) at the ostium of circumflex artery and moderate stenosis (40%) at the ostium on OM1 branch seen.
-The PDA,PLV & D1 branch are unremarkable.”
On 20th feb 2013 he had undergone coronary angiography ( with procedure approach –Right Femoral,left coronary catheter as –JL- 4 6 F,right coronary catheter as JR 4 6 F,Contrast agent as LEKPAMIDOL)
It shows following results with effort Angina as indication:-
-Native arteries
LMCA- appears normal
LAD – is a type II and small vessel showing proximal non-critical plaque extending into small D1 which is shows ostial 80% lesion.Mid LAD shows 70-75% lesion followd by minor plaque in its distal segment.D2 shows ostial 70% lesion.
LCX – is non –dominant vessel showing 90-95% lesion immediately after OM1. OM1 shows ostial 90% lesion followed by proximal 95% lesion.
RCA – is dominant vessel showing proximal plaque followed by ectasia.PDA shows 90% lesion in its mid segment .PLV shows 90% lesion after bifurcation.
Renel arteries : right renel artery shows ostial plaque.
          Left renel artery appears normal.
Others : LIMA and XXXXXXX appear normal.
Hemodynamic Data :
LV status :not done,
AO Pressures : 140/70 mmHg
The Dr finally diagonises with Triple vessel coronary artery disease and recommended for CABG.
My questions are :-
Is the above method to check the bloackage in heart with angiogram is fully correct?
IS the difference between CT angio past 5 months and current angiography significant?
What method we should go for to have a normal life (CABG or stent)?
How long can we wait ? and should we try alternate medicine or therapy?

Posted Sun, 17 Mar 2013 in Hypertension and Heart Disease
Answered by Dr. Prabhakar C Koregol 16 minutes later
Yes angiogram (Conventional not Ct) is gold standard for the diagnosis of block and report is likely to be fully correct.

CT has lot of limitation and especially with high calcium it only an approximatation and no need to comapare two. Once you have concentional angigram you can forget about what ever CT told.

With kind of blockage you have discribed in report CABG appears to be best option.

If his symptoms are only exertional there is no emergency but you should getting done in short term as there is always risk of major cardiac events such as heart attack or heart weakening as long as the blocks are present.
Above answer was peer-reviewed by
Follow-up: Diabetes and hypertensive. Getting chest pain, nausea and breathlessness. CT angiogram done. Suggestion? 21 hours later
how much time do we have for bypaas,if we control his diet,give him atmost 2gm salt a day,through some yoga and small excersice.?If we regularly take medicine(of sugar,BP,aspirin) is there any chances for increasing of the blockage? if there any ,then in how much time it can increase?

How the doctors had so accurately measured the percentage of blockage? is this measurment just an approximation or is it measured by calliper/software.? How much differentiation is acceptable in this measurment.?

i also have CD of angiogram ,how can i show you for the same.?
Answered by Dr. Prabhakar C Koregol 20 hours later
It’s very difficult to say how much time you have, as the cardiac events such as heart attack are unpredictable. When diet, yoga and exercise is followed it may reduce chances but will never make it zero. Yes, despite the medicines, the blocks can progress albeit at slower rate.

With experience cardiologist can accurately estimate the blocks and also all XXXXXXX labs have a software called Qunticath which can give measure of severity. I don’t have an answer for how much differentiation in measurement is acceptable.

If you want to show CD, someone will have to see me in person at Bangalore in my clinic.
Above answer was peer-reviewed by
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