Suggest treatment for cardiac stress test abnormal without operation
Patient: My husband is scheduled for a cardiac cath tomorrow morning because his nuclear stress test came back abnormal. He does not have angina. He has had a bit of loss of energy and endurance. Those were his only symptoms. We were told there is an 85% chance there is a 70% blockage in his RCA. I know once you have the stent, there is no turning back so I am hoping for clean arteries. We would like to have a conversation with the doctor before the procedure to make sure he doesn t decide to put in the stent if my husband could manage without it. What questions should we ask or how could we present it so he knows we trust his judgement, but really want to be conservative here? When is the Fractional Flow Reserve (FFR) indicated? Doctor: Hello. Thank you for your question and welcome to HCM. I read your query and understood your concerns.Allow me to start my answer with an analogy. Stent placement in a coronary artery is a remedy to the artery, as it is taking antibiotics when you have sore throat. If there is a blockage greater than 60%, then placing a stent is reasonable. There are no drugs or therapeutic remedies that would cause regression ("growing down") of the intracoronary atherosclerotic plaque. With the maximum of usage and dosage, they could stop it from building up, at best. Percutaneous coronary intervention (PCI: balloon + stent) is a safe and effective treatment of intracoronary plaques. It is accompanied with a great deal of symptom relief. With the right and proper care after the stent implantation, it should be successful. As about the fractional flow reserve, it is used by the operator when he has doubts whether to deploy a stent or not. In this term, I would only speculate if I gave you a precise answer, because I would had to see it myself. Summing up, my opinion and recommendation is that, if that plaque results over 70% in coronary angiogram, a stent should be implanted. At the end, the choice is always yours.I hope I was helpful. Take care and good luck!