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Have some ostial stenosis in second diagonal branch off the LAD. Something to worry about?

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Cardiologist, Interventional
Practicing since : 1996
Answered : 192 Questions
Had a heart XXXXXXX done in XXXXXXX this year. It was normal per my doc except I had 40-50% Ostial stenosis in the second diagoanal branch off the LAD. Is something I should be worried about?
Posted Sun, 29 Apr 2012 in Hypertension and Heart Disease
Answered by Dr. Raja Sekhar Varma 2 hours later
Thank you for your query.

I understand that you have diabetes and hypertension, which are risk factors for coronary artery disease.

I would also like to know your cholesterol levels. If not done already, kindly get a fasting lipid level done and upload the results. I would also like to know if you are a smoker, and whether there are any first-degree relatives who have had heart disease.

As you know, there are two main coronary arteries - the left coronary artery and the right coronary artery. The left main coronary artery divides into the LAD (left anterior descending) and the left circumflex artery. The LAD is by far the most important vessel, since it usually supplies a large part of the heart muscle with blood. The LAD has diagonal branches and septal branches.

From your report, the second diagonal branch has a 40 -50% ostial stenosis. Stenosis refers to blockage in the artery as a result of accumulated cholesterol debris below the inner lining of the blood vessel.

However, this degree of blockage does not hinder the flow of blood. A hemodynamically significant block is usually over 70%. Also, the size of the diagonal branch is also important to know how much of the cardiac muscle is served by this branch. Usually, these branches supply blood only to a small portion of the heart muscle. Even complete blockages can be well tolerated, if there are other branches to the same area.

The major risk with these 40-50% lesions are that they might result in acute chest pain, when the inner lining overlying the plaque breaks and the cholesterol debris is exposed to blood. The blood then forms a clot which can cause a sudden blockage to blood flow and result in a heart attack.

The fact that the stenosis is at the origin of the diagonal branch may mean that the blood clot may extend to the main LAD as well. This is the only cause of concern.

The good thing is that this has been discovered before any such event has taken place. With good preventive measures, you can definitely avert an acute coronary syndrome.

You need a good diet which is sugar free, with reduced salt and complete avoidance of fat (as far as possible). Avoid fried food, red meat, egg yolk, ghee, butter, cheese, cream, etc.

You also need to put in at least 30 minutes of walking per day. This is the simplest and most effective means of exercise to prevent cardiovascular problems.

Metoprolol and lisinopril are two drugs known to prevent progression of heart disease, in addition to controlling your blood pressure. It is good that you are on both these medicines.

ASA is aspirin which can prevent acute events by their action on platelets.
In addition, I would also recommend a statin, either rosuvastatin or atorvastatin for controlling your cholesterol levels. Since you are a diabetic, a small dose of statin is recommended even if your basal cholesterol levels are normal. You could discuss this with your treating physician. He will guide you with the appropriate dose and the specific drug.

It goes without saying that you should control your BP and blood sugar effectively to reduce the risks of a coronary event.

Since the blockage is only 40-50%, and since it is only in a diagonal branch, there is no necessity for angioplasty or surgery at this juncture.

I hope this answers your query. Feel free to contact me for any further clarifications.
With regards,
Dr RS Varma
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