lad bypass

[Maxbar]

70% stenosis to LAD rest of arteries fine consultant unsure about putting me on the bypass list.any thoughts.

[Fanfab1]

the question is why is the consultant unsure?

[Maxbar in reply to Fanfab1]

he thinks because I am still able to be quite active and not in any discomfort ,he would like to see how I am on my meds I have had a balloon stent . and he will see me in January to discuss further, have got an appointment next week with another consultant ,it was the surgeon who thinks to wait and see , so I suppose I can discuss with my other consultant and see what he says, thanks for your reply 👍👍

[Fanfab1 in reply to Maxbar]

That makes sense, As your active it seems natural surgeon would want to see if the stent and meds do the job, good luck with consultant interesting to see their opinion. I’d guess the consultant may say the same - see how you get on with stent and meds. I’m sure you’ve thought of this, keep a diary so you can keep track of how feeling , what been able to do or not and any side effects / issues. Hope you don’t need surgery! 👍

[Maxbar in reply to Fanfab1]

thanks again for your reply it does all make sense ,but you know how it is with your heart your always anxious ,will keep you informed how I get on ,what is your ailment,?

[Fanfab1 in reply to Maxbar]

Anxiety is only natural. I have a congenital heart defect that can’t be helped with meds or surgery, I get chest pain on exertion. 👍

[Maxbar in reply to Fanfab1]

I presume the meds do keep it under control, good luck with all you do 👍👍👍

[Maxbar in reply to Fanfab1]

still waiting for a heart MRI scan feeling OK in my self booked in to talk to surgeon consultant as soon as scan has been assessed ,presume that will be by end of January , waiting is not helping but I know people are a lot worse of than me ,so need to keep positive 👍👍

[Fanfab1 in reply to Maxbar]

The waiting is always pants. Once you get a date that will help. But I found waiting hard.

Sometimes knowing others have it worse doesn’t always reduce our own anxiety - I personally think thats ok. ❤️

Keep us posted!

[Chappychap]

Blocked arteries (atherosclerosis) doesn't correlate particularly well with the risk of heart attacks and strokes. There is some link, but it's no where near as clear cut as we generally assume.

Some people have very high rates, and can be virtually crippled by angina, but have never had a heart attack. While other people have levels of blockage that are so low they're difficult to measure or even observe, yet have suffered multiple heart attacks.

You don't mention if you've ever had a heart attack, but if you haven't, and your other risk factors aren't particularly high and you're still able to lead an active life, then many doctors will be reluctant to move straight to surgery.

Bypass surgery is very well understood, but it still carries some risk (on average about 2% of patients encounter serious problems during surgery), so your doctor will want to know that in your individual case the benefits clearly exceed the risks.

Good luck!

[Maxbar in reply to Chappychap]

thanks for the reply I have not had a heart attack,and before my diagnosis I would swim 3 times a week run once a week and walk at least five miles a day.I have now kept up the walking but swim less and do not run which I really miss as I have run all my life,

suppose I need to see what develops.

cheers again 👍👍

[RailRover in reply to Chappychap]

Perfect reply to the question, Chappychap.

[Wooodsie]

Why have you stopped running Maxbar? I know you must have had some symptoms at some point, but you don't say when or what these were.

Have you been given a GTN spray? I used to use this before exercise such as running, prior to my double bypass op.

If you do get to have the op, you need to be as fit as possible. I would suggest you ask both of your consultants to what extent can you exercise, this is probably more important than anything (in my unprofessional opinion of course 🙃)

[Maxbar in reply to Wooodsie]

hi woodsieThanks for your reply I have been told I can excersise but monitor closely and ease back rest if any pain or breathless ,I did cycle but was advised to stop that as an attack could endanger others.fair comment .

I might be panicking a bit ,when swimming last week got sharp pain in my chest this was the first really worrying thing that has happened .

maybe I just need to come to terms with the whole situation ,calm down and start again slowly,👍👍👍

[RailRover in reply to Maxbar]

Pain can be due to anxiety now that your condition is out in the open. Before, you were in blissful ignorance.

[Maxbar in reply to RailRover]

your correct 👍👍

[fairgo45]

70% is not a huge blockage but it depends where it is in the LAD.My 2 blockages were 75 in the LAD the other was in a branch off that.

It was picked up during an angiogram so no heart attack.

There was never any discussion about a bypass I just had them both stented..

This was a couple of years ago.

Ask your cardiologist why he's even considering it.

[Silvertail in reply to fairgo45]

I wondered about that too. Doesnt a stent “fix” it? My LAD is 50% blocked but they don’t bother about it unless it gets to over 70%

[Beamgirl in reply to fairgo45]

I wish I had the option of stents. It was picked up from angiogram.

I was well so total surprise, only symptoms were a little breathless in winter walking the dog and meds sorted that out anyway.

I am still not right a year on and had to battle with g.p as had been signed off by all.

Now had MRI stress test and CT scan 16 weeks ago, finally got results, doctors strike hasn't helped. Found another LEX blockage now which was missed but evident on last angiogram.

[fairgo45 in reply to Beamgirl]

Put your foot down get a cardiologist who listens.Mine always says be a squeaky wheel then you'll get something done

[RailRover in reply to fairgo45]

Sometimes the arteries can be tortuous (tightly curved) and unsuitable for stenting. In my case, I have the RCA stented after HA, and the other 3 bypassed for this reason.

[Jem64]

After anepisode of hypertension and an angiogram in April I was told I needed a triple bypass and had 95% blockage. It was also confirmed I had experienced two strokes. Stents were not an option apparently.Commenced meds and under my own advice stopped alcohol and reduced carbs.

Feeling very well. At this point I'm not considering surgical interventions.

I also take cayenne pepper and Taurine .

[Tommo46 in reply to Jem64]

I had a 77% blockage in LAD which cannot be stented due to location. It is being dealt with by medications and if they continue to work as they have done for 2 years I am more than happy to avoid surgery and the associated risks during and after. However, as the medics have said, every case is different so if your consultant has given a full explanation of why your treatment is good for you, trust him/ her.

[Retroluxer]

Why isn’t stenting option?

[Maxbar in reply to Retroluxer]

no good landing point for stent???there words not mine,

[Hrty in reply to Maxbar]

I have a similar problem. Blockage in small artery very close to the junction with a healthy main one. Cardiologit has drawn umpteen diagrams showing why it would be difficult, risky and not really an option.

[fairgo45 in reply to Maxbar]

Landing point ?The LAD is one of the most straightforward to stent.

[RailRover in reply to fairgo45]

Every case is different. I couldn't have one there either. Tortuous artery.

[Beamgirl]

I would go on the list. I had an LAD bypass last , scenario as you with 50% blockage and stents/meds not an option.

[Maxbar in reply to Beamgirl]

I was all for the surgery ,it was the surgeon who is not sure and wants time and more tests to evaluate,his words were I am undecided at this point which is the best option, let's have more tests and look again, had echocardiagram which showed heart working fine,just waiting for a stress test. which not got date for yet but see consultant next week so will discuss👍👍

[RailRover in reply to Maxbar]

I can understand his view. None of us have a crystal ball, and if you are relatively well, active and can be controlled by meds it's very reasonable that he is reluctant to move straight to surgery. I had a very similar situation, and I spent 10 days under observation in CCU, so finely balanced was the call. I'd already had HA 18 months earlier and been stented to RCA. After getting similar "warning" symptoms, and knowing I had severe (90%+) stenosis in the other main arteries, I was admitted via A&E. No HA on this occasion, thankfully.

During those 10 days I was constantly monitored on ECG, and had a few echo cardiograms. I had several long conversations with the cardiologist in which we both scratched our heads over the best thing to do. Should we persevere with meds and see if the symptoms (severe angina-ish at times) improve? Should we bite the bullet and put me under the knife? He was completely honest in that he had no idea what would be best in my case. Nobody could know. I might be discharged with my meds and a few days later have a massive HA and die. Or I could live for decades at the same level. On the other hand he could refer me for surgery and I may have a bad outcome, another HA during or after surgery, etc, etc. Or I could be transformed back to my earlier fitness levels. He said that they try to err on the side of least intervention, as nature is always best if it can be helped along. However, he left the final call to me, and said he would support my decision. I didn't blame him for not having superhuman insight into the future, and I thanked him for his candour. I'm pleased that I went for the surgery thus far, but I know that nothing is guaranteed in life and it could have turned out differently.

[MountainGoat52]

Hi Maxbar,

I had a heart attack caused by a blood clot and had two overlapping stents in my RCA. It all came as a surprise as like you I was fit and active, maintaining daily walks, often of 10 or more miles non-stop and at pace. I was found to have a 50% blockage in my LAD and another artery and was offered bypass surgery. I was told by the surgeon that I could have more stents rather than surgery, but he felt it would benefit both me and the NHS for me to undergo the op. I decided to go with his advice, though the decision was entirely mine. The bypass was a triple as the stents in my RCA have been bypassed as well as the two bypasses on the left side.

Being fit and healthy was a key factor in me being offered surgery. Had I not been so active then it would have been a case of having more stents. I can see the quandary that your surgeon has.... you must be on the cusp where the benefit of surgery is around the same as having stents. It is a fine line and will vary with the opinion held by the surgeon or consultant.

I agree with Wooodsie in that whatever the outcome of this, you need to keep fit. You obviously enjoy exercise, so maintaining the variety seems sensible. I would say just don't overdo it.

After my HA and stents, my cardio-vascular system was so improved that I took off 6kg in the first week and the weight has stayed off. I also found I could stand and chat to someone for an hour or more without having the backache I'd suffered for years. Other things improved as well, like I no longer got a build up of lactic acid in my leg muscles when climbing hills. Amazing fhings our bodies... the functioning of the cardio-vasular system is so vital.

The benefit I felt after surgery was less dramatic. I suppose it was masked by the impact of the surgery. I felt really well while in hospital, but I was only walking the corridors and stairs in the department. When I got home walking up the hill to my house was impossible for the first week or so. Thankfully I improved daily and at 8 weeks post-op I broke through the 10 mile non-stop walk barrier, though it took me 3 hours. I've picked up the pace a bit since then. 😉

I really hope that you get resolution of whether stents or a bypass are the best option for you. I certainly have not looked back since I recovered from my op and I am still enjoying walking the mountains in Scotland aged almost 72. 😀

Gerald

[Maxbar in reply to MountainGoat52]

thank you for that uplifting reply👍👍👍

[HarryJ81]

I had 90% stenosis to my LAD (mid to proximal location) - consultant put a stent in and sent me on my way. She said there was no reason for a bypass. Each of these things is a case by case analysis I think.

[dlowell]

Stent technology and procedures are now extremely advanced and effective. I would exhaust all stent due diligence with a top cardiologist specialising in PCIs before undergoing a bypass.

[tunybgur]

Hi Max,

I had 90% blockage in the distal LAD which was not possible to stent. That was 11 years ago.

I believe statins have stopped this getting any worse and have stabilised the plaque.

I also understand the heart has the ability to create local bypasses called collateral flow allowing people with blocked arteries to keep going with just a bit of angina.

Good luck

[Maxbar in reply to tunybgur]

that's an interesting post my consultant did say something along the same lines. thanks for that, isn't the whole subject so complicated 😂😂💔 I will have a areally good talk with the consultant next week and see where we go from there 👍

[Fish4Info]

I've scanned most of the 34 replies at the time of my writing this. My guess is that the reason the consultants are unsure how best proceed is that, while significant, your 70% LAD blockage probably isn't severe enough to warrant an definitive course of treatment. What seems to be good news is that your cardiologist is speaking to a cardiothoracic surgeon!

More of my arteries were more severely blocked (85-90%) when I had a CABG×4 17 years ago when I was 47. The cardiovascular disease was too severe to warrant stenting.

Although very definitely a scary time, the op went well, and I have been generally fit and well since. After my op, I did cardiac rehab, including exercise support and diet advice. I ended up reducing my BMI from 31 to 25, and being pretty fit (for a 50 year old). Sadly the years had an effect - and the weight crept back on. I am currently trying to lose it again.

One thing they introduced in cardiac rehab was Borg Index of Perceived Exertion. I can't find a great NHS reference for it, so here's a US one: cdc.gov/physicalactivity/ba...

If I were in your position, I'd probably be wary of trying to run like Usain Bolt, but go for something more moderate ... like brisk walking. If I got chest pains with more exertion, this could be an indication of angina, and I would stop/reduce exercise intensity. Pain going away as exercise reduces could be a further indicator of angina. If the chest pain persist - or you are worried - don't mess around but call 999.

Hopefully by January, the way ahead will be clearer to the medics ... but I'd also be wondering if a second opinion would be worthwhile.

Hope that helps.

Best wishes,

Fish4Info

[Maxbar in reply to Fish4Info]

thank you for the information ,I will take it on board, and hopefully find the best way forward eventually ,hope you keep well and get your self in a good place 👍👍👍