coronary disease

Q: I have suffered from coronary disease problem in 1995 as I had heart pain and was admitted to the hospital. The diagonosis after angiography, ECHO, TMT, Thallium test indicated two vessel heart blockage (Lateral wall). I am continuing with medicine. The ECG is normal and had also been normal at the time of discharge from hospital in 1995. But the discharge note had indicated infarction and suggested for bypass surgery in the planned way. I have not gone for bypass surgery but since then continuing on medicines - betaloc-20, monotrate and cardiovit. I am getting my TMT done every 6 months. The ST depression in 1995 was 3.2 mm but now it is around 3.8mm. I could continue TMT for more than 6 minutes and then discontinue due to fatigue. Kindly suggest whether to continue the medicine as above or any change is suggested or any other check if required to moniter the cardiac health. Shall I continue on medicine or go for surgery? I must tell you that i have not experienced any symptom / pain etc in heart or any part of the body which may indicate heart problem. Waiting for your reply.

A:I gather that you are a young man with established coronary disease, asymptomatic on medical treatment. The medical treatment is very important, continue that and keep your lipds very low - LDL Cholesterol less than 80 mgs, triglycerides less than 150 mgs and HDL Cholesterol more than 45 mgs. Statins and niacin are good for that. Keep your BP less than 140/85 mms Hg.
In addition, I think a stress thallium should be repeated to evaluate degree of ischaemia if the areas involved have increased and anterior wall also gets involved during exercise it calls for a repeat angiography. The need for revascularisation(PTCA /CABG) will depend on the area at risk.