Coronary Artery Disease on CT coronary angiography

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Submitted by Dr T on November 2, 2011 – 8:02am

Question: 
Dear sir,My father is 74 years old, and experied some chest pain along with pain in left arm and jaw some 20 days back.we got a CT coronory angiography done for him and following results were found:Calcium score: 2370Dominant artery : RCALEFT MAIN ARTERY:Eccentric calcific plaques are seen in LMA not causing any significant focal luminal narrowing.LAD: There is diffuse disease inproximal and mid LAD with multiple eccentric and concentric calcific and mixed plaques. Exact luminal assessment is difficult due to partial luminal obscuration and blooming artefacts of calcific plaques, however there appears to be significant 70 – 80% FOCAL LUMINAL STENOSIS in LAD at entry level of D1 origin.Long segment myocardinal bridging is seen in distal LADDiffuse disease inD1 vessel with multiple calcific and mixed paques.D2 is small in calibre and normal.LCA:There is a diffuse disease with multiple calcific plaques in proximal,mid and distal LCX 30 – 40% focal luminal narrowingRCA: origin is normal. Diffuse disease in RCA and PDA through out its course with multiple eccentric calcific and mixed plaques.Approx 50 – 60% focal luminal narrowing in distal RCA and significant focal luminal in proximal PDA.Kindly suggest how critical the situation is and can it be rectified with just medicines, because he does not want any invasive procedure.

Hi Tina,
These results show how far CT coronory angiography has come in diagnosing Coronary Artery Disease (CAD)! Your father has significant CAD, but treatment will depend on symptoms and other findings that requires further evaluation, including a stress test:
You can get an idea of what might be the best choice of treatment by completing this questionnaire (try it twice, once for two and once for three blockages in his coronary arteries).

In patients with stable angina, or otherwise not yet treated, “optimal medical therapy” is often a better solution than an intervention such as a stent or coronary artery bypass procedure.I have discussed this issue in My Opinion on CAD treatment.

Meanwhile, your father should consider changing his life style if possible.

Hope this helps,
Dr T

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