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Submitted by Dr T on March 9, 2012 – 3:43pm

Hello… I am 72 yrs old, and in reasonably good health, I think, considering I have not been in a hospital overnight since 1983, and that was for a D&C.  Now I need a knee replacement. I was going through all my pre-op screenings, etc.. and they find a “left bundle branch block”. They did another ecg, and it wasn’t there. Next day, not there, then did a chemical stress test, and apparently it was there. Now they want to do a heart catherization. IF there are no blockages, as in needing a stent, what, in your opinion, could my chance be of still getting the knee replacement, and if I do need a stent, what are chances, and how long, in your opinion, would it be possible to go ahead with the knee replacement. I have no shortness of breath, no palpatations, no chest pain. I do have hypertention and its completely under control. But I can barely walk very far, until the pain is so great in my knee area, that I have to find a place to sit, no matter where I am.  Thank You in advance.

Hi Loretta,
Your doctors are trying to find out whether you have coronary artery disease (CAD) and whether if so, it would increase your risk for a heart attack during surgery.

If the only finding is a LBBB, w/o other evidence of insufficient blood supply to your heart (called ischemia), an alternative next step to prove CAD is a cardiac CTCA (much cheaper and easier on you).  The results could indeed prove you have CAD, but since you are asymptomatic (no angina), that doesn’t automatically mean you need a stent or bypass surgery before your knee replacement (there are situations where this might be necessary, especially in so-called Left main lesions).

In asymptomatic patients with heart disease, medical treatment is often superior to stenting (the treatment doctors might recommend if they find CAD). You are correct in questioning your doctors about the catherisation!
Hope this helps,
Dr T

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