Hi Dr Phil
I was told after angiogram that they felt PCI of LCx small OM branch wasn't possible due to it being a small vessel. The centre is an acknowledged centre of excellence in UK. A consultant cardiologist has classed this procedure as urgent.
My worry is that they do PCI to RCA alone and nothing improves as LCx small proximal vessel is culprit for perfusion defect. Should they be able to tell from cardiac MRI which vessel is the culprit?
When you say PCI of LCx small proximal vessel is riskier by what magnitude or scale?
Finally, wouldn't medication like amplodipine or Isosorbide mononitrate be a better first try to see if one of those relieves what are fairly mild symptoms at present.
Sorry I may have misled you. The cardiac MRI was a CMR cardiac stress perfusion scan. It was the earlier coronary angiogram that visualised the LCx small OM branch occlusion and scale of vessel. Previous coronary angiogram in 2010 had only shown mild disease in LCx small OM branch and RCA at pretty much today’s level of stenosis. A cardiac MRI a few months later showed no ischaemia. This would indicate to a layman that perhaps the LCx small OM branch has become the culprit over the last four years and they wouldn’t have listed me for PCI unless they definitely thought they could relieve the cause of ischaemia now seen. Otherwise they would be doing just the RCA on the chance this was the culprit. An unlikely scenario I would have thought? Do you agree?
A cardiologist in the team also told me that a total blockage in LCx small OM branch would only cause a mild heart attack. Is that right?
Many thanks. This conversation with you has given me a much better focus on things.