I Have Non-Obstructive Coronary Disease. Why Doesn't My Doctor Want To Open All The Blockages?

— -- Question: I was told that I have non-obstructive coronary disease, blockages that the doctors don't want to fix. why shouldn't I just get all my blockages opened?

Answer: In general, we believe that blockages aren't critical unless they're more than 70 percent blocked, and what that means is one may have lesser severity blockages in the range of 20 percent or 50 percent that could be a problem in the future with regard to causing heart attacks or progressing to a critical severity, but at this particular time, they're not tightly blocked enough to create problems with creating abnormal stress tests or producing angina.

And the reason for this is the heart's very smart. The heart is able to dilate the arteries, and even if there's a blockage, the dilatation might allow enough blood flow to get there, and therefore the patient may not have symptoms.

Now, sometimes we can treat these blockages that are not critical with balloons or stents, but that may not be in the patient's best interest.

For example, there are risks involved with using balloon and stent procedures. We can tear the artery, the artery can clot, the patients could have a heart attack or death from one of the complications that we produce in the cath lab. And after we treat these patients, they're also required to take long-term medications to thin the blood, and if they don't take those medications, the patients could have a worse outcome compared to if we left the patient alone.

And it's for all those reasons that we really do not recommend treatment of blockages unless they're 70 percent blocked or greater.

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