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Heart attack. Done with angiography and having mild chest pains. Is it necessary to for surgery?

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Practicing since : 1966
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Dear Dr,

My dad (56year old) had a heart attack. Angiography was done and has confirmed:
1) There are two arteries blocked. (a) Left Artery, just below the LAD, and (b) Right, quiet low down (after almost 3 intersections).
2) The Left atery is not significantly blocked and that right is the culprit.
3) The right artery is at least 90% blocked.
4) There is no evidence of muscle damange. The inferior wall is a bit lazy, but still alive.

The concern for Dr is that the blockage in the right artery is quiet low, and a challenging place to reach, and therefore conducting Angioplasty and placing stent(s) is a risk. CABG is not recommended because only one blockage is significant.

He has been on medical treatment (cholesterol control, BP, Blood thinning (tablet and claxane twice a day) for the past 3 weeks, and feels relatively stable. He was discharged for a few days. While he was discharged, Dr did not give any claxane. He had very mild chest pains after two days.

He is not diabetic nor hypertensive.

I can email Angio stills and Mibi report.

Would you suggest that he remain on Medical treatment or go through surgical treatment?


Posted Wed, 4 Sep 2013 in Hypertension and Heart Disease
Answered by Dr. Anantharamakrishnan 12 hours later
Brief Answer:
Yes - he should go for CABG (bypass)

Detailed Answer:
Hi friend,
Welcome to Health Care Magic

He should go for bypass surgery ...
The aim of an investigation is to modify the treatment based on the result....
90% block / inducible ischemia / and symptom are indications for intervention.
Since angioplsty is a risk, bypass is a must... even otherwise, bypass is better anyway

Earlier the better – the aim is to prevent infarction
Aggressive management of risk factors is a must till then..

Take care     
Wishing speedy recovery
God bless
Good luck
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