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What Do The Following Test Reports Post Angioplasty Indicate?
Question: Dear Sir
About 3 weeks back on emergency I have undergone angiogram at one of reputed hospitals in XXXXXXX After the angiogram was completed the cardiologist informed my family that there are two paths of treating my ailment. One procedure is to put stent via angioplasty procedure and other one is by-pass surgery.
I am attaching herewith the following reports
1. First ECG taken as soon as I reached hospital File Name First_ECG.pdf
2. Coronary Angiogram Report Coronary Angiogram Report.pdf
3. Discharge Summary Discharge Summary Final.pdf
4. Last ECG taken after angiogram ECG XXXXXXX 19th.pdf
Since last month 22nd I am out of hospital and able to do my normal daily activities without much discomfort. Currently I have following doubts and need your second opinion whether it is really required to undergo stent / bypass procedure as proposed by the cardiologist.
1. I could not make out where the block is and what percentage from the angiogram report. Please help me in knowing the same.
2. In the discharge summary it was advised for thallium stress test after 2 weeks but in last consultation Dr. has differed it to 6 weeks. What for this thallium stress test required and why it is differed I do not know. Please let me know whether it is necessary or not.
3. What is PTCA to LAD and is it really necessary to do this in my case.
Appreciate you help
Regards
Nagaraj
About 3 weeks back on emergency I have undergone angiogram at one of reputed hospitals in XXXXXXX After the angiogram was completed the cardiologist informed my family that there are two paths of treating my ailment. One procedure is to put stent via angioplasty procedure and other one is by-pass surgery.
I am attaching herewith the following reports
1. First ECG taken as soon as I reached hospital File Name First_ECG.pdf
2. Coronary Angiogram Report Coronary Angiogram Report.pdf
3. Discharge Summary Discharge Summary Final.pdf
4. Last ECG taken after angiogram ECG XXXXXXX 19th.pdf
Since last month 22nd I am out of hospital and able to do my normal daily activities without much discomfort. Currently I have following doubts and need your second opinion whether it is really required to undergo stent / bypass procedure as proposed by the cardiologist.
1. I could not make out where the block is and what percentage from the angiogram report. Please help me in knowing the same.
2. In the discharge summary it was advised for thallium stress test after 2 weeks but in last consultation Dr. has differed it to 6 weeks. What for this thallium stress test required and why it is differed I do not know. Please let me know whether it is necessary or not.
3. What is PTCA to LAD and is it really necessary to do this in my case.
Appreciate you help
Regards
Nagaraj
Brief Answer:
Yes , The treatment plan is appropriate and justified for the case
Detailed Answer:
Hello , I am Dr. Mody and I would be addressing your concern.
I went through the history and all the attached reports.
As I start I would like to reassure you that whatever treatment your doctor has offered is in accordance to standard of care followed throughout the world .
You had a massive heart attack due to 100 % occlusion of the Lad territory. Now that was because of a 70 % lesion in the start of LAD territory which was superimposed by a clot which occluded it completely resulting in the heart attack . Now by giving that clot bursting injection they helped dissolved the clot and hence establishing the flow , however the baseline 70 % stenosis remains . Now Generally 70 % or more stenosis , revasularisation helps , whether bypass or stenting .
Now for if anything needed of two , stenting would be preferable according to me for three reasons .
1) In the angiogram it's mentioned that the distal lad is diffuser diseased , when you put a graft on such vessel , the chances it may close or not grow are higher
2) you are non diabetic and hence there is good chance that the stent will fare well .
3) bypass should be reserved for a later date , as you are young and it's only one vessel involved, with the other two completely nomral .
Now as your lesion was boder line , 70 % , it can also be managed medically like it's being done now .
PTCA to lad means to put stent in lad .
However if stress thallium, where they see the perfusion of the heart during stress , if abnormal , means that medicine itself is not enough are nd something has to be done to improve the flow furthur for maximum recovery of the heart muscle.
However 2 weeks will be two early to know that as the heart is still recovering from the attack injury , so differing it accordingly is worthwhile . 6 weeks would be fair .
Hopefully I could resolve your doubt.
Let me know if any clarification is needed and I would be happy to help.
Regards Dr Priyank Mody
note . Do continue the medicine religiously for maximum benefit.
Yes , The treatment plan is appropriate and justified for the case
Detailed Answer:
Hello , I am Dr. Mody and I would be addressing your concern.
I went through the history and all the attached reports.
As I start I would like to reassure you that whatever treatment your doctor has offered is in accordance to standard of care followed throughout the world .
You had a massive heart attack due to 100 % occlusion of the Lad territory. Now that was because of a 70 % lesion in the start of LAD territory which was superimposed by a clot which occluded it completely resulting in the heart attack . Now by giving that clot bursting injection they helped dissolved the clot and hence establishing the flow , however the baseline 70 % stenosis remains . Now Generally 70 % or more stenosis , revasularisation helps , whether bypass or stenting .
Now for if anything needed of two , stenting would be preferable according to me for three reasons .
1) In the angiogram it's mentioned that the distal lad is diffuser diseased , when you put a graft on such vessel , the chances it may close or not grow are higher
2) you are non diabetic and hence there is good chance that the stent will fare well .
3) bypass should be reserved for a later date , as you are young and it's only one vessel involved, with the other two completely nomral .
Now as your lesion was boder line , 70 % , it can also be managed medically like it's being done now .
PTCA to lad means to put stent in lad .
However if stress thallium, where they see the perfusion of the heart during stress , if abnormal , means that medicine itself is not enough are nd something has to be done to improve the flow furthur for maximum recovery of the heart muscle.
However 2 weeks will be two early to know that as the heart is still recovering from the attack injury , so differing it accordingly is worthwhile . 6 weeks would be fair .
Hopefully I could resolve your doubt.
Let me know if any clarification is needed and I would be happy to help.
Regards Dr Priyank Mody
note . Do continue the medicine religiously for maximum benefit.
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Answered by
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