Just diagnosed with Coronary Artery Disease

Hi, so as above, after putting it off for months for various reasons i went and had a cardiac CT last week and my dr. informed me via email (because i emailed him for the result) that i have CAD. He sent me the report and i've done some reading. It all sounds a bit scary to me. This is the main part:
............................................................

REPORT:

Quality: Good
Dominance: Right

LMCA: No significant disease

LAD & DIAGONALS:
LAD: Proximal high risk mixed plaque with positive remodeling and 70%
luminal stenosis. The narrowest cross sectional area is 3.5mm2
D1: Large branching vessel. Proximal eccentric mixed plaque with 30-50%
ostial stenosis
D2: Small vessel. Poorly visualized

LCX & MARGINALS:
LCX: Proximal mixed plaque with 50-70% stenosis. Terminates in a LCX
extension.
OM1: Small vessel. Poorly visualized
OM2: Large vessel. Proximal mixed plaque with 30% luminal stenosis.
PL1: Small branching vessel. Poorly visualized

RCA & BRANCHES:
RCA: Dominant vessel. Diffuse disease with 50% stenosis in the proximal and
distal vessel.
PDA: No significant disease
PL1: Small vessel. No significant disease

NON-CARDIAC FINDINGS:
No significant incidental findings are seen in the field of view

CONCLUSIONS:
Triple vessel disease
...................................................................

I'm 53 and have never had a heart attack or any angina or tightness in the chest, stroke or anything else like that. I have other health problems but not heart related (until now). My reading tells me that "mixed plaque" is not good, more prone to rupture etc. 70% and 50-70% blockage sounds like a lot. My dr. told me to start on 100mg aspirin daily which i did today, and i will see a cardiologist asap. I guess my questions are: how bad is it (it looks bad to me), what do you think would be the recommended treatment (stents? bypass of some kind? I'm terrified of bypass because my health in general is not great, i have significant fatigue from my other health issues and i worry about how i would recover), can i still do moderate exercise now (i usually swim 20mins or so at a moderate pace when i can). Also i live alone, but have a few friends within a short-ish distance. What is the real risk of gastro bleeding from 100mg aspirin daily? Any other advice? On the one hand, i've obviously been living with this for years now without knowing it, so i feel like i should try and continue on with my usual daily routine (i don't work), swimming, riding bike to see a friend etc., pottering at home, and try not to worry, just leave it to fate. On the other hand many things in the report scare me.

Thanks for any info.

Danny in Sydney.

danny, off to the cardiologist for you mate. sounding clogged up. i had dpass, 70% and 50% but they were in awkward spots, so they bpass. i too take perindiprol and aspirin and spiractin-fluid. best ya speak with the cardiologist, depending on location they will stent but i am no cardio. a triple would be bpass in the main, esp for larger % blockages. keep calm, ya in safe hands. ht, from down under.

nah, piece of p1ss mate. i do recommended you do cardio rehab, it's a must. i was walking and stuff straight away. sternum re-knitting does tickle a bit, did it without pain meds. my former gp was a ****!!!! i was on a plane 6 months after to the uk, all good. and i am diabetic!!!

Hi Danny, HT is spot on with his reply. Wait until you see the cardiologist & get his opinion. This could go either way depending on what the specialist thinks. With any surgery the drs get you up immediately. The risk of just laying in a bed could cause unwanted things like pneumonia & even blood clots. My brother was up walking the first after his surgery with the assistance of nurses. Walking is crucial with recovery.Seems like the day of surgery they got him up to sit in a chair. He too went to cardiac rehab after his surgery, that is pretty much standard here in the states.

Keep us posted on how you are doing.

Update: So i saw the cardiologist yesterday. He calmed my morbid fears a bit ... says i'm much more likely to get away with stents (85% or so) than having to have bypass, but even if i had bypass, he said i'm a good candidate for it because i'm relatively young, 53, and in "good" health, at least compared to the 70 and 80 year olds he sees who have bypass (and are up and about resuming activities within a week or two!!) His asst did an ultrasound and my heart has no damage and is functioning well. I did have to start on Crestor (Rosuvastatin) last night, and statins in the past have always made me sick so i stopped them, but i will have to try and stick with it this time, feel a bit yucky today but not too bad really. Diet/ex will not be enough to reduce my lipids.

He's scheduling me for an invasive angiogram at St. Vincents soon and depending on what they see (he actually said the CT i had often *overestimates* the level of blockage .. i had read the opposite), they can put the stent/s in there and then.

So it's still a big deal obviously and i'm a natural worrier, but he calmed me down a lot. Will have to take an anti-platelet as well after the procedure. darn, i was just starting to eliminate drugs! (got rid of 3 recently), now i have to add more back in. Oh well. This is life and ageing i guess.

Danny.

Thanks. I'm doing that (stress reduction). Mood is getting a lot better.

So for anyone still reading my little story, i had the angiogram at St. Vincents yesterday and unfort. the result was bad, much worse than the CT, many more blockages. CT had a high of 70%, angio says there are several 70s, 80s and a couple of 90%s. And yet, i still have *no* symptoms. Every dr i saw wondered why i had the CT in the first place (because i'd had elevated lipids and my dr urged me to). Surgeon said i need quadruple bypass, bloody hell. I know HT says it's no big deal but it's major surgery to say the least. Anyway, i will contact the (female) cardiac surgeon Monday and make an appt. I had a fantasy thought last night that maybe i could go without the op. if i just took my aspirin, my statin, ate a perfect diet and did some exercise - maybe i could stop the blockages where they are (producing no symptoms for me), but i guess that's probably not going to work since most chol is not dietary anyway. When i read about bypass online, it keeps saying "bypass does NOT prevent future heart attacks" .... i don't understand that. Heart attacks are caused often by blocked arteries, so if you 'bypass' blocked arteries with good ones, why doesn't that prevent future heart attacks, and if it doesn't, then why the bloody hell are we doing them??? That one's a head scratcher. This board is not so busy, but i'll keep putting my updates on... Danny.

Well i'll be in a public as well, St. Vinc., the surgeon i'm seeing is Emily Granger - i just looked her up and she's a bit of a star so that's something. I'd like to hear your story ... is there a post here you can link to?

Danny, I looked up your Dr, and yeah, her bio certainly does red like a Rock star.

I had 3 blockages 2 years ago. LAD 80%, LDX 85%, and RCA 50%. The first two were stunted.
Sucks that you need to go through the surgery, but you'll get through it. It's major surgery, but fairly routine nowadays. I would never go against. Drs advice on something like this. But with that said, I also wouldn't have this type of surgery without a second opinion.

When an artery is blocked, very often the body compensates, by growing Collaterals, sort of like its own bypass. This might be the reason you have no symptoms.

Re lipids, you CAN improve your lipids with diet. My triglycerides were in the 300's for years. After the stents were put in I went VERY low carb, as well as completely wheat free. My TG dropped to 86!
My LDL-C dropped to 43, from bout 70mand my total cholesterol dropped from 150 to 86 (the Cholesterol and LDL were part diet and part statins, I'm on low dose 10mg crestor.

There is a very good website, www.cureality.com that I got a lot out of. It's not mainstream, and some of the folks on the forum are a bit too fanatical for my taste, but it might be worth looking at.

Stress is another big factor. I went for biofeedback breathing training and it's helped me (I think Zoloft helped me as well, with anxiety issues, very important to control)


Bypass or not, control the things you can control, and don't stress, or try not to, over what you can't control. It's a waste of negative energy, to no good end.

Please keep us updated, I'm interested in following your progress.

Good luck.

Thanks HT, but no rock star here, just a patient trying to squeeze all the juice i can out of life.

Hey Danny, any update?