Looking for advice

[Ianmac1957]

Hi everyone I am 62 yr old male

Results from coronary angiography

Diagnosis Coronary heart disease

( left main stem 50-60% maximum less severe in other views)

(Right coronary artery moderate 50-60%)

Left ventricular well preserved

Intermittent claudication

Hypertension

Asymptomatic carotid stenosis

(Right side 90%blockage)

Since August my medication is

Adizem xl 240mg

Aspirin 75mg

Atorvastatn 80mg

Indapamide 2.5mg

Glycerol nitrate ( I don’t use)

When I first went to doctor blood pressure was 220

I have monitored my blood pressure from September through October

Average is 129 / 65

Heart beat of 55

I have changed diet am walking 4 km minimum per day

I am scheduled for bypass surgery this Sunday 17 th

My question is should I go through with bypass surgery or continue with medication and push for Carotid help

[MichaelJH Heart Star]

Hello and welcome to the forum! I am slightly surprised as I would have thought they would have addressed your carotid artery first. Somebody I know had their bypass delayed when they found this issue at the pre-op. Can you talk to your GP or cardiologist?

[Ianmac1957 in reply to MichaelJH]

I am trying to speak with my cardiologist tomorrow I spoke with my surgeon s secretary today I gave her my concerns I only found out about my carotid artery damage 12 days ago she basically said if I don’t want the surgery they can’t make me and that carotid artery with 90% on one side would not warrant surgery

I don’t want to miss out on something I need but I have worked at lifestyle diet and exercise and thought I was doing well now I feel confused

[MichaelJH Heart Star in reply to Ianmac1957]

You need to speak with the professionals - it is definitely not a secretary's call! As Calliope153 has said they do not undertake bypass surgery lightly and only after considering medication and stenting options. Let us know what they say.

[Calliope153]

The only people who can advise you on this decision are the surgeon, cardiologist and GP as they are the people with training, see all your records and then draw on their experience and professionalism to make a judgement. My advice is to make an urgent appointment with at least two out of the three and discuss everything thoroughly; go with your questions written down and take someone with you. As resources are so squeezed it is unlikely you would have been offered surgery on the 17th if a team had not reviewed your records and come to the conclusion that you could not be controlled with medication, lifestyle changes and exercise. But it is your body and you choose whether to go ahead or not. The key is informed consent - you still have a lot of questions you want answered so the people to talk to are your care team. Good luck.

[Ianmac1957 in reply to Calliope153]

Thanks yes hoping to see cardiologist tomorrow timing is very tight

[Ianmac1957 in reply to Calliope153]

My cardiologist had a meeting to discuss my need for bypass with specialists at Torbay hospital who agreed I should go for bypass but this was before I was tested on my carotid artery he never told me the results he only mentions it at the end of a letter saying it was significant and he was treating it conservatively and asked if that was ok with the surgeon from Plymouth

It was only when having my assessment for surgery from the Plymouth team the assistant to the surgeon said I had 90% blockage I have not received a letter or anything to confirm this I have had no conversation with my cardiologist at Torbay to confirm or to tell me this without that assistant letting slip I had 90% blockage I would not have known

I feel as though they are trying to treat me like a fool no increase risks explained no discussion on what to do first just take it or leave it

[Healthyheart1 in reply to Ianmac1957]

Hi Ianmac1957, reading through the posts I do hope you get all your questions answered before 17th. Good luck x Sheena x

[Sillyfroggy in reply to Ianmac1957]

Just found the NICE guidelines for you.

Also this, from the NHS.

My brother had a carotid dissection a couple of years ago and his was 55% blocked and they said to him they would look at stenting around 65-70%+.

I’m originally a South Devon girl, grew up in Kingsteignton and have hazy memories of wine coolers in The Mousetrap!

[Sillyfroggy in reply to Sillyfroggy]

Idiot, didn’t post the links!

nhs.uk/conditions/carotid-e...

nice.org.uk/Guidance/IPG388

[Ianmac1957 in reply to Sillyfroggy]

Thanks for ur help got appointment with cardiologist tomorrow will find out what my carotid blockage levels are as I have no official in writing result of ultrasound test the secretary couldn’t give me them and said the reason I have not been told is they sometimes don’t want to overload people with figures my blood pressure has shot up this morning

Thanks again to everyone here for there concern and help

[Fortepiano]

Current guidelines recommend revascularisation for anyone with left main stenosis of 50% or more, even if they have no symptoms, as medical treatment gives much poorer results, and the majority of the heart depends on the left main for its blood supply, making any heart attack from a blockage there particularly severe.

So whatever you do about your carotid artery, it's certainly not recommended to rely on medical treatment for left main problems.

I hope your surgeon helps you to a clear way forward for both problems.

All the best

[Ianmac1957 in reply to Fortepiano]

Thanks to everyone for helping really great forum

I won’t be having appointment with cardiologist my choice

The stress of trying to pick best journey pushed blood pressure to 197 /85 time to trust my doctors and try and relax made me realise how much stress affects my condition

Thanks again

[Ianmac1957]

Thanks for the info I didn’t know that