Coronary bypass second opinion

Posted by jbhook @jbhook, Aug 1, 2022

Hello,

Here is my situation:

Male 62.5. 6ft, 195 lb. HBP – no. High cholestoral – yes. Diabetes – no.
Exercise – Yes. Smoke – yes. 2-3 cigars /week. Never smoked cigarettes.

Few months ago I had a cardiac treadmill stress test.
Which I had just cause I wanted one: had no symptoms. But I do have a history of high cholesteral and family history of CAD.
Had no difficulty doing the test (9 mins 135 bps), but a little ‘blip’ appeared for a just a few seconds.
So, my regular Doc sent me to a cardiologist.
Cardiologist did not even think I should have had the stress test, since I had no symptoms……… but since I did: he ordered a Coronary CT scan (which my insurance refused to cover at first (lack of symptoms), but the cardiologist got them to agree))
The CT scan showed some blockages.
Next up, had heart cath (angiogram). This showed 2 blockages. Cardiologist did not do anything (angioplasty/stent) because 1 blockages was, he said, 100%.

Still no answer as to why, if I have a 100% blockage, I have no symptoms (agina, short of breath, tiredness, etc, etc….even upon exertion: walking biking, mowing, etc.).

But……my next stop: Cardiac surgeon – August 4th. Who I am SURE is going to recommend by-pass surgery.
If that is the case, I want to be able to get a 2nd opinion.
Does Mayo do those for my situation.

Thank you.

Interested in more discussions like this? Go to the Heart & Blood Health Support Group.

What ever the recommendation is be sure you have a well experienced Doctor. I have a total of four stents. My first experience almost killed me, the second stent the Doctor implanted he got stuck and I had a heart attack on the table and ended up in Cardiac Care for four days. I now have a diagnosis of Chronic Ischemic Heart Disease caused by the "stuck stent" incident. Interestingly, my Cardiologist didn't want to talk about it so I changes Dr.'s.
After this experience I have found that most Doctor's don't want to take on a patient with this diagnosis. I feel like a guinea pig there doesn't seem to be much scientific data available for a case like mine.

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Hi @jbhook and welcome to Mayo Clinic Connect. So are you saying that the scan showed 100% blockage? Mayo does see second opinions, although the circumstances vary from patient to patient.

What made you decide to get a stress test with no underlying symptoms?

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Regarding cardiac stress tests, I did one (also because of lot of heart disease in family), and it was normal, but 6 months later I went to my local ER for something else and blood test showed elevated troponin, so they did angiogram and discovered 70%-80% blockage. 70% blockage is the threshold for putting in a stent. I had shortness of breath, no real chest pain.
You don't mention location of the blockage. Did the Coronary CT scan provide blood flow measurements?
The recommendation by Don45 to find doctor with experience is excellent! Check out the hospital also. See US News report for information on hospitals.

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@amandaa

Hi @jbhook and welcome to Mayo Clinic Connect. So are you saying that the scan showed 100% blockage? Mayo does see second opinions, although the circumstances vary from patient to patient.

What made you decide to get a stress test with no underlying symptoms?

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I have had high chloestoral. I have been on a statin for quite a few years. My Dad had multipe by-pass for CAD. My sister recently had a stent put in. I had stress tests through work many years ago. Never showed anything. See my primary care Dr. regularly. He knew of high cholestoral and had even changed statins a few times. But, since I never complained of any symptoms he never recommended stress test.
But given all the above I thought a stress test might be good. So my primary care guy ordered one. Dominos fell as described …and here I am headed to the Cardiac surgeon. I just cannot understand, with a supposed 100% blocked artery…….that I have no symptoms. I also got no chance to talk to the interventaioal cardiologist about the the what he saw during the heart cath. My guess is he saw the 100% block and just said "I'm out". Not sure if he has the means or skill to do a PCI.

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There are blockages and then there are blockages. My former cardiologist described how the body can create its own work-arounds, a kind of self-bypass. Maybe you don't have any symptoms because something like that has taken up some of the circulatory burden? Prepare a good list of questions to see what the physician thinks and choices may be offered.

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Update. So, have not even met with the Cardiac surgeon (tomorrow), yet I get a text from the local hospital that he has already set up a echocardiogram for me on 8/8! I find this a bit odd (maybe even disturbing) as I have never spoken to the man. Really feel like I am being rushed here. Does this seem odd?

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I'd want an echocardiogram done. And it doesn't lock you into anything else including surgery. So, to me it sounds like the physician is organized and responsible. Since a lot of medical facilities are swamped now that people are out of lockdown and needing to take care of medical things they'd had to postpone, it's getting harder to make some appointments. Booking the test reserves a time for you.

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@jbhook

Update. So, have not even met with the Cardiac surgeon (tomorrow), yet I get a text from the local hospital that he has already set up a echocardiogram for me on 8/8! I find this a bit odd (maybe even disturbing) as I have never spoken to the man. Really feel like I am being rushed here. Does this seem odd?

Jump to this post

@jbhook I don't think it's unusual when my cardiologist order this test I didn't see anything improper .You must have talked to some Dr .? This only means Dr is getting more information on your heart

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No. I have not talked to the Dr. that orderd this test.

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@jbhook It's only a test I didn't talk to my cardiologist either about any certain testing He knows what he needs for your benefit .I don't understand why your so reluctant .It was either your Cardiologist or PCP that ordered it .It won't hurt you I,ve had that and more test before my triple by pass 26 yrs ago and I'm still living

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