Myocardial perfusion scan Normal. Coronary Angio shows blockage? Please advise...?

I am Normal healthy 52 years old male. I have been getting my complete health check up every year including tread mill(STRESS) tests & Echo Cardiogram. In fact, the doctors whom I used to have a regular check up were tired of seeing me and used to tell me I am just fine. I alwsys achieved 100% THR.

Last month I did CT ANGIO,Why ? I have no symptoms whatsoever.I did beacuse the meachine installed was NEW and my doctor suggested, instead of stress test this year I do CT Angio,which showed some deposit calcium flakes.

After a few days I did CORONARY ANGIO. The report: LAD - TYPE -3 VESSEL,PROSIMAL LAD HAS 80% BIFURCATION LESION INVOLVING THE ORIGIN OF A LARGE DIAGONAL(D1). D1 IS A LARGE VESSEL HAS OSTIAL 80% LESION. DISTAL VESSEL IS NORMAL.

LCX : OM3 IS A MODERATE VESSEL HAS LONG SEGMENT 80% LESION IN PROSIMAL SEGMENT. I was advised CABG Surgery.

Subsequently I went through stress test which was normal and MYOCARDIAL PERFUSION SCAN, The Report:

NO EVIDENCE OF PERFUSION DEFECT IN THE ANTERIOR WALL,SEPTUM,LATERAL WALL OR INFERIOR WALLS. ACHIEVED 100% THR. ASYMPTOMATIC AT PEAK STRESS. NO FRESH ST CHANGES SEEN AT STRESS OR RECOVERY.

LVEF AT PEAK STRESS 65%. NORMAL MYOCARDIAL PERFUSION PATTERN.

COMMENTS : NO EVIDENCE OF INDUCIBLE ISCHEMIA IN THE MYOCARDIAL TERRITORIES DESPITE THE LESIONS SEEN ON CORONARY ANGIO & CT ANGIOGRAM STUDY.

The Doctors are divided over surgery. some for it and some are against it as stress test and thallium stress test is totally negative.

I go t om Gym regularly and walk atleast half hour on the t read mill covering 3.5 to 4.5 Kms five days a week.

I am confused and depressed,. Can you please advise me.

Many thanks for your time and help in this regard


Jay

Your cardiac cath is your best result since its the only internal procedure that was done. I am a coronary intensive care nurse at one of the top cardiac hospitals in the US. I take care of the sickest of the sick. Has your interventional cardiologist told you that andioplasty and stenting were not an option? Usually at 70% blockage of any of the major vessel biforcations (LAD, RCA, Cx) an angioplasty(PTCA) and stenting is always considered as the first option to fix the blockages, however, some lesions may be to "tight" to try to open and it may lead to bad complications, or the lesions are in a bad area to angioplasty(a tiny balloon is used to squish the plaque to the outer edges of the vessel). I certainly would get another opinion at a large cardiac hospital and not just a small hospital. Just because you don't have symptoms now doesn't mean that you are ok. If your shower drain pipe were 80% blocked you know that its only a matter of time before the blockage gets worse or suddently stops up the tub.

As a CICU RN for 10yrs in a very reputable cardiac hospital, I recommend, that you see another interventional cardiologist for their opinion. Medications alone will not make your situation reversible. You are a young man and if you don't have any other major health concerns,you would more than likely be a good candidate for surgery since you are so active right now. Avoiding the facts won't make your situation better. Many of my patients families tell me that their loved one just had a stress test recently and were fine, but then somehow end up in my care in the ICU. If you have 80% blockage, the red and white blood cells from the blood traveling through the 20% of the vessel that is open can stick to the plaque and cause a clot which will quickly cause a heart attack.

Please get another opinion Jay. I'm giving you lengthy advice because this is my specialty. If needed, have a reputable interventional cardiologist do another cardiac cath on you if necessary.If he suggests surgery, ask him for the one he would allow to cut into his wife or daughter!! Good luck.

sir, i don't have much knowledge about medical language but it seems the same case as that of my father he is very active and around 4 yrs ago he got some symtoms like he was not having control of one side parts of body like arm, hands, eye etc. we immediately shown to doc he suggested angiography. and slight artery blockage was reported by this test. however, all other reports were normal . so what i meant to say is if angio is indicating something , you must get alert. you cannot keep your eyes closed and think that all is well, if other reports are suggesting so. i must advise you to pls. check with some specialist in this field who has lot of experience. only he can guide you properly. in my father's case, he got surgery done, and is now as active as he has been always.

Surgery may be performed only if it is advised as obligatory. Seek a second medical opinion.

So are you thinking you should have stuck with the treadmills? :)

I think that it is good that you found out about these blockages because now you get to decide what to do about them. You don't mention any symptoms, so I assume you have a little time to research the subject yourself. You sound very active, but you haven't mentioned anything about diet or your lipids. You might want to look into the literature about reversing coronary artery disease with diet. Dean Ornish did it with a strict vegetarian diet plus lifestyle modifications. Caldwell Esselstyn did it with a strict vegetarian diet plus cholesterol-lowering drugs. The latter has a new book out about it, which I thought was very good. I think it is very good news that coronary artery disease can be reversed without surgery (which is risky, as you know), but I don't think it has caught on yet in the medical community in general. In any case, if you are interested, it is something positive you can do about this newfound problem. Good luck.

All tests have there limitations and coronary angiography is the gold standard, i.e the most accurate. Based on this you have significant heart disease that will require life long multiple drug therapy irrespective of whether surgery is performed. This has been proven to reduce risk of serious complications in the future (heart attack, death).

The reason for different results on the other tests is as follows:

(1) Standard treadmill ecg test is only 70% accurate at best and can easily miss blockages

(2) Myocardial perfusion scan works by comparing differences in blood flow to different parts of the heart. If all areas are equally effected (triple vessel disease) then there will be reduced flow to all regions and no difference seen by the scanner, leading to a "normal" result (false neagative).

As far as surgery is concerned: There is no right or wrong...
A recent large study COURAGE TRIAL showed that in patients WITHOUT symptoms or with STABLE symptoms, there was no added survival benefit by fixing the blockages compared with just using the best combination of tablets.

Also other good trials have showed that there was only a benefit in surgery for 3 vessel disease if the heart contraction was reduced esp if there was diabetes. Heart contraction is regarded as normal if it is more than 55-60%.

So in conclusion, you have multiple blockages and need a good combination of medications prescribed by a cardiologist. Surgery is not essential based on no symptoms and good heart contraction. But a lot of people would have surgery in your situation based more on "if there is a blockage, lets fix it" rather than proven clinical data. In a way you can safely choose either option, but if you decide not to have it fixed, you will need to be seen regularly by a cardiologist.

This advice is based on what you have wriiten, but please remember that there may be other relevant information not mentioned. So please talk to a cardiologist before making a final decision. The internet is useful but not as good as talking to an expert with all your clinical information.

Don't get too depressed. Heart disease is very common and you can lead a normal life with help from the doctor.

All the best