Yes the collaterals are presumably well-developed. The danger from over exerting himself through exercise isnt of much concern, he would be symptom limited well before there was irreversible damage. Other issues like sepsis could put some strain on the heart but unlikely to cause any sizable infarct.He needs to really maximize the medical management - strict risk factor control with high-intensity lipid lowering therapy (doesnt matter if cholesterol is high) and tight monitoring of blood pressure. If there is a hint of diabetes one of the newer agents also would be good.The medicines actually work quite well combined with lifestyle changes. CABG and stent are more bailout procedures if a lot of heart muscle is threatened by very narrow arteries, which is not the case here.
This is an incredibly thorough reply, thank you for taking the time to explain all of that. My clinical brain cant function because all I can think about is getting another phone call and it being about him.So if Im understanding correctly, it sounds like the collateral vessels are more effective than I assumed. Hes a pretty active guy, is there danger if the left side cant meet the metabolic demands of the heart during exertion? Any risk of right sided ischemia?Ill be joining him at his appointment to take notes and make sure hes compliant with those lifestyle changes. He still thinks this is all routine and not a big deal. Your reply is helping me catch my breath a bit, so thank you again.