How to find which lesion is causing angina in multivessel CAD ?

Yes, it is a triple vessel disease, with one tight lesion and at least two other significant lesions. One of them appears diffuse as well.  Representative Image: Source courtesy DOI: 10.14740/cr548w LicenseCC BY-NC 4.0 “What to do next?. Is he symptomatic?  Yes. Definitely has significant angina” but LV function is normal. “Ok then. If you are daring enough, ask this question”. Which lesion is causing angina? No easy answer at all. Try looking for some clues right from history, ECG, stress ECHO, meticulous assessment of individual lesions. Realize, even sophisticated imaging like SPECT, PET functional MR, may not help much either. Oftentimes, we need to use the lean resources of collective common sense and clinical acumen.  If it is post ACS status,  consider residual ischemia in the culprit artery is the cause for angina. Second, consider the tightest lesion as angina-related. Or the complex, eccentric, thrombotic lesion is responsible. Next, consider LAD as default lesion as  angina related artery (Statistically right 75%, prognostically perfect decision)  Watch for ECG changes during chest pain (ST depression usually don’t localize, but experience tell us V5 /V6 ST depression is more likely to be LAD ischemia ) Echo wall motion defect either during rest or (more usefully) in stress can really help. (It needs some effort to look for Wall motion mapping with coronary lesion subtending segment) What ...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: Cardiology - Clinical Cardiology -Definitions cardiology- coronary care Ethics in Medicine Uncategorized ACC AHA ESC Guidelines for multivessel cad angina related artery ara vs ira approach to tvd cabg vs pci vs medical maangement ov cad Source Type: blogs