left anterior descending artery

[carrick22]

I've joined this community for an understanding really of why, when my wife has been diagnosed with Heart Disease, left anterior descending artery, with 45% stenosis, she has been told that apart from the drugs she has been issued there will be no more follow up or regular 'checks' to monitor if the situation is getting any worse. I'm left feeling a little confused as to the approach of the GP's & consultants?

[Maisie2014]

Yes it is confusing and worrying. I would think that if your wife has been given medication to control the blood flow and the cholesterol in her arteries then she will be followed up albeit with blood tests. Speak to your GP and ask what kind of follow up she can expect. After my heart attack I was discharged but I am regularly monitored with blood tests and I had an ECG this morning just to make sure all is well. I had 90% stenosis.

[Chappychap]

There doesn't seem to be much of a preventative culture when it comes to heart disease in the UK, so unless you present with a heart attack or serious angina symptoms then you won't be offered much. Having said that it's important to appreciate that 45% stenosis really isn't all that bad, from the feedback on this forum (I'm not a doctor so that's all I have to go on) it's unlikely that there will be any symptoms until the 70-80% stenosis range or even higher. I was 90% before I was really conscious of breathlessness for example.

Another key point to recognise is that heart disease is incurable, all you can really hope to achieve is to slow or arrest the progress of the stenosis with medication and, even more importantly, life style changes. Most importantly that means,

-weight in safe BMI zone

-waist measurement half of height or less

-Mediterranean diet, in particular strictly limit all processed foods and refined carbs

-150 minutes of moderate aerobic exercise per week (excluding the warm up and cool down periods)

-quit smoking

-focus on stress reducing techniques

There are others but these are the important ones.

Good luck!

[SunshineGardener in reply to Chappychap]

Excellent advice.

[Speakeazi]

I am in a similar position re the LAD. I also have PAD. I pay to have a ultrasound of my legs each year and see my vascular surgeon after.

But I don’t understand how will I know when my LAD goes from 40% if my LAD is not monitored.

I need to transfer into the NHS and don’t really understand how this monitoring happens so I don’t have to have a HA.

Any info would be great. Ty

[fergusthegreat in reply to Speakeazi]

Unfortunately there isn't any routine monitoring in the NHS because of the cost but also the fact that if you don't have a heart attack it can take 10 - 20 years for a moderate 40% stenosis to progress to the point of causing angina and needing treatment.

If you want to monitor your progress, as you do with the PAD you will also have to go privately and probably get a non invasive test like a cardiac CT with FFR or a cardiac Mri profusion scan.

[Speakeazi in reply to fergusthegreat]

Thank you. Best to know ahead and start saving the pennies fir the private cardiac ct.

[ChicagoGirl1961]

It's good that your wife was diagnosed as early as she was. At 45% she will most likely be asymptomatic. She has been afforded the opportunity to combat this disease before a significant cardiac event occurs. It's worth considering a whole food plant based diet. There are many valid studies that document the success that many have achieved in halting the progression of heart disease, and also actually lead to some regression of atherosclorosis in some instances with a whole food plant based diet and other healthy heart lifestyle changes. Being diagnosed early rather than in the latter stages of the disease is quite a blessing because you have the opportunity to fight the disease and not let it progress to a point that it causes significant health and quality of life issues.

[Hidden]

I know it can all be quite frightening but 45% stenosis of a cardiac artery is not classified as of any significance so try not to worry.

Whilst there will not be any hospital follow up, she will be monitored by your GP because of the medication. It’s easy to say “don’t worry” but simply take this as an indication (a warning if you will) that perhaps some lifestyle changes are called for. Good luck

[Sunnie2day in reply to Hidden]

Yes, true, but really, couldn't they say something along with 'don't worry', like here's a leaflet on how to manage to not worry? I get the NHS is stretched to far beyond limits but wouldn't it be more helpful to patients if something like a three-ring with guidance was handed over when the consultant says 'You're now discharged'? Lifestyle changes needed to manage heart trouble wants guidance.

I've lived with heart trouble most of my life (RHS since the mid-1960s, recurrent pericarditis since the early 2000s) so have the knowledge of how to self-manage, but newcomers to heart disease may not have that awareness of where to look for credible guidance. When my recurrent pericarditis morphed into angina recently - just when I was meeting a new GP - only knowing where to look on the BHF website for publications and downloads helped ease a lot of my anxiety - but no-one, from GP to cardiologist thought to mention where and how I could find ancillary information. That should be automatic, and would lessen some of the strain on the NHS, I'd think. (oh dear, I think I've descended into a bit of a rant, and I don't mean it to sound that way!)

[Steuey]

You may be interested to know that the situation is much the same in Australia. Following a HA in March 2016, I had a stent placed in the RCA. I have been under the care of a cardiologist since then, with medication, diet control and 12 monthly follow up appointments, while asymptomatic. I had an angiogram in August last year, following some relatively minor angina, which revealed 25% stenosis in the LAD, a level of no concern to my cardiologist. The treatment strategy was to continue with diet and medication, with my next appointment again scheduled for 12 months. In June of this year however, following more bouts of angina and some breathlessness, a further angiogram was arranged revealing 80-90% stenosis in the LAD, resulting in a stent placed within the next 4 days.

While conservative management of CAD is the international practice, one hopes that a life-threatening HA is not the incident which triggers treatment with stents or other more invasive surgery. I think the bottom-line must be that you do not hesitate to see your doctor or specialist at the first sign of symptoms. I know from personal experience that this can be difficult, as you can tend to play “mind games”, questioning whether your symptoms may just be your anxiety getting the better of you, influencing you to delay seeking medical assistance. However, I suggest you put that to one side and get to the doctor and insist on further investigation, as this may prove life-saving!

[Sillyfroggy]

She could poss ask her cardio for a pressure wire study. It is gold standard for moderate stenosis as it’s not always the super blocked arteries that cause the HA. It’s more about plaque stabilities, and smaller stenosis can be the least stable. The HA is actually caused by the process that takes place if a bit of the plaque flakes off, triggering a load of chemicals that helpfully make a clot, thus blocking the artery.

The pressure wire test is not fun.

[fergusthegreat in reply to Sillyfroggy]

The pressure wire test is called fractional flow reserve for your information 👍

[Sillyfroggy in reply to fergusthegreat]

My cardiologist called it pressure wire study 🤷🏻‍♀️

[Milkfairy Heart Star in reply to Sillyfroggy]

The fractional flow reserve is measured using a fine wire that measures the blood pressure within the artery and the flow of blood.

Commonly called a pressure wire study or fractional flow reserve assessment.

It is used as a guide to help aid the Cardiologist to decide whether a stent is the best treatment option.

There is a condition that Cardiologist are prone to known as

' Ocular stenosis reflex ' see blockage stent it!

[Frigid]

Insist on changing your doctor or consultant or both it seems they are more interested in them selves or to arrogant to apply the proper procedure, I did for my husband when he was diagnosed with so many things HF, Diabetes, myeloma, then Parkinson’s it seemed to me they had given up with him till i intervened and complained, they soon changed there mind and treated him as a patient should be, not as a problem that will sooner or later go away, voice your objection it works. Write to the medical council.

[fergusthegreat in reply to Frigid]

Your critism of the doctors is totally unfounded and unfair.

Standard of treatment for moderate stenosis is medication and lifestyle changes, unless you have a heart attack or angina.

You can go privately and demand an angiogram but I'm not sure if anyone would do it as part of the hypacratic oath is to do no harm and an angiogram does carry a small risk and does not seem warranted at the moment

[Frigid in reply to fergusthegreat]

I’m sorry what you are thinking but Its my experience what is in the oath and what there actions are, The higher the are and once there mister is granted they get more and more arrogant I have had to complain on two occasions and things did improve.

[carrick22]

All, thanks for all the really useful & helpful comments & I think Stueys comments re, the increase in stenosis levels and when or if they occur, who is to know this if no one monitors, are really relevant. The first instance of increase you may know about is when it’s to late and you’ve had an HA already. We exercise regularly and have a healthy diet, so all we can do is carry on in that vein (no pun intended) and push for more screening in say 3 years or if the NHS won’t wear that, go private at that point. Again, many thanks.

[fergusthegreat]

Stuey had what I think is called accelerated progression of atherosclerosis. If you read some medical studies of atherosclerosis progression you will see that the normal annual progression of Lad stenosis is about 1 - 2 % so you could have years before you need treatment.

Alternatively you can have a heart attack tomorrow. It's this uncertainty that I find the hardest thing to deal with even 3 years after my stent but uncertainty in many forms is just a part of life.

[Steuey in reply to fergusthegreat]

I think Sillyfroggy’s comments may well be relevant in my case. As I apparently have quite unstable plaque generally, I have wondered whether the substantial increase in the percentage of plaque over a relatively short period, (from 25 to 80% in several months) may be explained by some plaque breaking away and creating a blockage “downstream”, so to speak? I did mention this to my cardiologist, however he was only lukewarm on the idea, so I still feel in the dark. Hope he is right, as I do feel like I have a time bomb in my chest occasionally!

[fergusthegreat in reply to Steuey]

I think you might be right as I don't think it's possible for such a large increase in such a short time.

My 60% Lad stenosis increased to 90% in a year and required a stent. This was put down to plaque erosion and subsequent thrombosis however the 30% narrowing in my Rca had not changed.

[Sillyfroggy in reply to Steuey]

The blockage isn’t caused by the plaque itself. It’s actually caused by our own natural clotting mechanisms which create a clot over the leaking liquid plaque from the broken bit (same as if you cut yourself). The degree of stenosis is not necessarily related to plaque stability - smaller plaques can rupture equally. Obviously where the stenosis is massive it won’t take much to tip it into heart attack!

[Maisie2014]

Doctors are only like mechanics fixing faulty cars. Some of us are old bangers that need repairing constantly and taking care of. Some brand new cars develop faults that need to be fixed. Either way it’s not the fault of the mechanic that the problems aren’t fixed. The onus is on the owner of the car to make sure it’s maintained and regularly serviced with the correct oil and fuel. Apparently I’ve reached the grand old age of 68 because I’ve lead a healthy life with a good diet, regular exercise, no smoking or drinking but the family history still gave me a heart attack. You have the knowledge and it’s a worry but you can work on it.

[Milkfairy Heart Star in reply to Maisie2014]

Great response Maisie2014

I am now visualising what sort of car I am.

A red Porche of course 🚘. Okay I admit it I am an aubergine mini 🚙

[Maisie2014]

The first one that spring to mind Milkfairy is the 1960s E Type Jaguar. Slim, sleek, fast and attractive. I’ve probably got a bit of rust on the chrome these days and I’m not so slim either 😂

[Milkfairy Heart Star in reply to Maisie2014]

Yes I thought of the E type Jag too. Good choice!

I can't image that you could possibly have rust on your chrome though😉

[Speakeazi in reply to Maisie2014]

Has to be a red Ferrari Dino, classic, rare, bubbly and fun!

[Lezzers in reply to Maisie2014]

Could I just have a land rover please. 🚙