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Forum Name: Ischemic Heart Disease

Question: ADDITIONAL BLOCKAGE IN ONE YEAR


 Floyd Michel - Sun Nov 18, 2007 10:51 pm

My 78 year old wife had two taxus stents placed in a curve of the Circumflex heart artery one year ago. No chest pain but high blood pressure treated with Alivide. She has been taking Lipitor,Plavix and coated aspirin for a year. A narrowed but not serious aorta valve was also involved. She feels ok and goes shopping frequently. She was advised that a recent stress test indicated blockage and poor flow of blood to the heart. In view of the current publicity concerning stents,the courage trial and cardiology protocol in general, we are very confused and we would appreciate very much opinions on the next best step for treatment of the current blockage Many thanks.
 Dr. Chan Lowe - Fri Jan 25, 2008 9:48 pm

User avatar Hello Mr. Michel,

Unfortunately, this is not my specialty so my knowledge is a bit limited regarding this. I suspect that the area involved is a different area than where the stents were placed but it is possible that the stents have clogged again.

I have seen that many patients now are having bypass surgery but this is purely observational and not based on any data. I would recommend that you talk with a cardiologist about the various treatment options to be able to get up-to-date information about the options available, the risks and the benefits of each option. This way you can make an informed decision.

I am sorry I cannot be of more help regarding this.

Best wishes.
 Dr. A. Madia - Tue Mar 04, 2008 1:12 pm

User avatar Dr Chan, may I add some input to this?

Dear Floyd,

Does your wife have diabetes? If yes, she is a likely candidate for silent isachemia and may not even be realizing that she is having angina. If she is a not diabetic and if she can perform all her physical chores without symptoms, then just because a stress test shows some abnormality does not necessarily mean another cath.

Courage trial specifically says that 'OPTIMAL' pharmacological treatment is equally good or even better than PCI. Chronic stable angina can be very effectively treated by proper therapy and your wife's current status is- Coronary disease yes but she does not even have an angina.

However you may suggest to your cadiologist if he thinks it fit to order a stress thallium. This will show if the blood perfusion of the heart muscle is actually taking place or not and in which territory and how much. It is entirely non-invasive. If stress thallium is significantly abnormal, one may think of going to the cath.

Apurva

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