Angiogram

[MMurt]

Hi

This is my first post. I had an angiogram on 18/12

The diagnosis was

Aortic regurgitation and dilated aorta on venticulogram appears severe

LAD disease mild angiographically , but positive pressure wire study

I didn’t have a stent inserted

I have af ,two ablutions partially successful

I would like to know more about this diagnosis as I’m in the dark about the future

I am 71 years old

[Kristin1812 Heart Star]

Do call the BHF helpline. You will get a good professional view from them. The members here are very good at sharing their own experiences, and I hope someone with similar problems might come along soon, and discuss them with you.

[Kristin1812 Heart Star]

Sorry I forgot to add this. Heart Helpline team on 0300 330 3311 Mon-Fri 9-5pm or email [e-mail]

[MMurt in reply to Kristin1812]

Thank you Kristin very helpful

[Cliff_G]

Hi MMurt, apologies for late reply.

The LAD first, this means the Left Anterior (front) Descending coronary artery, which is probably partly restricted due to atherosclerosis. It's mild hence probably nothing to worry about short term, but they intend to do a further test to measure just how restricted it is. As you say, stenting is one option, and this is so routine these days.

From my own aortic problems and those of others I know, I would be asking some questions about your dilated aorta, and the "appears severe" (why this appears on the ventriculogram, or what that really is, I don't know).

You don't say they have any further tests planned for that aspect; I would be asking why not. e.g. is the aortic valve regurgitation due to a dilated aortic root, or some other reason, and either way, what are the sizes measured of the root and ascending aorta? These can be measured on echo, which is the most likely first line test they should give you. However, echo is notoriously difficult to get accurate aortic sizes from, and is very dependant on the operator and exactly where and how they measure it. Echo is however excellent for visualising the valve and how well it is working. But the most accurate method of measuring the aorta is either MRI or CT, and they should be ecg-gated so as to "freeze" the image of the beating heart and pulsating aorta for the best accuracy.

In the long run you might (or might not) need to be considered for surgery, hence this is the primary question to your doctors.

Aortic surgical intervention is based largely on diameter, the "old" figure being 5.5 cm at which the risk of an operation becomes smaller than the risk of living with a diseased aorta. However, surgery is getting much safer with new techniques, and the limitations of a simple figure of 5.5 cm are being recognised. Some doctors recommend intervention at 5.0 cm or even smaller; definitely lower if you happened to have a "connective tissue disorder" such as Marfans (genetic tests are required to know this).

In the meantime, the most important factor is to keep your blood pressure well under control. This means 120/80. The NICE and UK recommendation on BP is to treat over 140/90. But this is based on atherosclerotic disease progression and does not account for the direct effect of BP on the aortic wall stress. You should discuss your BP with your doctor. Similarly, atherosclerosis can affect the aorta negatively, and cholesterol control is also important, so statins or similar. Good diet and exercise also genuinely help.

Good luck with finding out more about your situation. This is not something to worry about, but I would say is something definitely to clarify with your doctors.

[MMurt in reply to Cliff_G]

Hi CliffThank you for your very comprehensive answer

I am having a ct scan next Sat9/1/21 at Royal Free Hampstead ,I’m not sure if this is for the LAD or the aorta

Also mentioned on my angiogram report about need to have echo, I am slightly worried about attending hospital at the moment because of COVID but more worried about my heart as I get a lot of palpitations that I didn’t have before.

BP averaging at 130/58 due to increase in ramipril,also on rivaroxin and atorostatin 40mg and isosorbide monoitrate

Thank you again

[Cliff_G]

Great, sounds like the standard things are under control, and once the CT result is through you should get a chance afterwards to discuss with the Cardiologist.

The increase in palpitations may be due to the regurgitation, since it has long been believed these (and AF itself) are caused by stretch of the heart muscle. I've also had an ablation for AF but I still get ectopics as well. I've found 2 x 200 mg/day of magnesium citrate has helped (your mileage may vary!)

Best wishes