AboutDavid Richardson Expertise Adult heart function and disease. Not very good about children lesss than 12. Hypertension is o.k. Heart rhythm a special interest.
Experience Certified in cardiology by the American Board of Internal Medicine. Was chairman of division of cardiology at the Medical College of Virginia. Am now mostly retired.
Organizations Fellow of American Heart Association and American College of Cardiology and member of American Physiological Society..
Publications Circulation, American Heart Journal, Hypertension.
Education/Credentials M.D. from Harvard Medical School. Residency training at Yale Uhniversity School of Medicine and Medical College of Virginia.
Awards and Honors Gold Heartt Award from American Heart Association in 1995.
Question First of all I salut you because you are doing a great job for ill people of the word. God may give you reward.
My aniographic report is as under
Catheter Procedure:-
Through right femoral artery Salinger needle Pigtail no 6F passed to aorta and LV after injecting heparin. LV aortic pressure recorded.
Aortic Pressure 165/75 mean 110 mm Hg
LV 130/5 mm Hg
EDP 12 mm Hg
Left & Right Coronary Angio done with Judkins Coronary Catherter no 6F
Angiocardiogram Report:-
LCA LMS: Normal
LAD:Long area of critical disease proximal course.
LCx:Dominant. Maj OM has moderate disease.
RCA: Non dominant with moderate disease.
LV Angio: Ant wall hypokinesia with overall mild LV dysfunction. EF 45%.
My Myocardial perfusion report is as under:-
Clinical History:- A 43 year old man a known case of IHD, who had an anterior MI (SK+) in 2003 and an inferior MI in March 2007 and is presently asymptomatic. He is positive ETT with anterior hypokinesia on 2-D-echo. Coronary angiogram show multi vessel disease with a long critical segment in proximal LAD.
FINDINGS:-
Myocardial perfusion stress images show areas of much decreased to minimal radiotracer uptake in the apex, adjoining septum and apical to mid anteroseptal wall, with minimal to absent tracer uptake in almost all of the posterolateral LV wall. Rest images show minimal change in the mid to basal posterolateral and part of the mid anteroseptal wall, with tracer redistribution noted in other areas.
2. Moderate sized posterolateral fixed defect, with peridefect ischaemia (confluence of RCA and LCx territories)
Q-1 Please explain above report specially impression 1 and 2 in detail and advise accordingly.
Q-2 How much area of my heart has been damaged. (pleae tell me percentage of damage)
Q-3 Do I need stenting if yes then which stents DES or BMS? Can I implant BMS stents because I am a poor Pakistani and could not afford DES due to high cost
Q-4 Does this situation lead to CABG?
Q-5 Does I have blockage if yes then what is its percentage
Q-6 What is the best option for me.
With regards
I will be more thank full to you
Shabbir Ali Naqvi
Answer Dear Mr Naqvi,
1. The stress report shows scar from your previous heart attacks in the front and side walls of your heart with surrounding areas that are not scarred but are not getting enough blood supply to contract well.
2. The percentage of damage is not stated, but your EF of 45 shows that your heart is pumping satisfactorily. EF of 50 and above is normal. Your heart is not greatly damaged.
3. The main need for stents is chest pain you can't tolerate. Aspirin, a beta blocker, a statin and an ACE inhibitor provide as good protectioon against heart attack and cardiac death as do stents. In my opinion, you don't need any stents if you are truly asymptomatic.
4. CABG is needed only when 2 or 3 of the main coronary arteries are severely narrowed. Only your anterior descencing artery is severely narrowed, so you don't need CABG.
5. The report does not give % narrowing of arteries. "Critical Disease" probably indicates 80-90& narrowing.
6. I think the best option for you is medical therapy. The drugs listed above and any other meds needed to be sure your blood pressure and cholesterol are always normal, plus a good diet, regular exercise like walking half an hour every day, and no cigarettes.
Please write back if this note doesn't answer all your questions.
