Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Worried about my dads cardiac cath resultsMy father is a stubborn mule of a man, and I need to know if Im right in pushing this issue until he gets the care he needs. I am a pediatric ICU nurse, so adults are not my thing.My dads history: 63yo male, normal BMI, moderate physical activity 5 days a week, former smoker x 30+ years (quit in 2017 when my son was born). He takes Repatha, losartan, baby aspirin, and ambien (he works nightshift & sleeps during the day). Generally healthy and active, only pmhx is high cholesterol (we are Cuban and he eats a very high fat diet and a lot of red meat), and two stents placed in 2017. Extremely extensive family cardiac history as follows (this is tough to keep track of so bear with me):His father: quadruple bypass, 5 TIAs then full carotid blockage, heart attack = died in 10/2014His mother: quadruple bypass, years later had MI & stroke = died 4/28/2008Brother #1: quintuple bypass in his 40s... died of heart attack in his sleep 5/2019 @ age 58Brother #2: stent in his 40sSister: MI (widow maker) & triple bypass 4/2019Brother #3: 3/2023 bilateral carotid 90% blockages, persistent A-fib.And those are just his immediate family. That history extends to every branch of uncles & cousins as well. They should give us a discount for buy two get two bypass at this point.My dad recently went for his annual cardiac appt and failed his stress test (he was unable to complete it) so they had him go for a cath. That revealed 100% blockages in several areas (diagram drawn by his doc here: https://imgur.com/a/0adwYqA ) but they didnt perform any interventions. The doc said theyd have to compare this cath to the one he had in 2017 to see the changes and decide how to proceed, but that he felt ok just watching things for now. His next appt is in June, and my dad seems to think all is well. He said oh it went fine, they told me my body made other pathways for the blood to flow. Ugh.I am alarmed. Cardiac isnt my specialty, but wouldnt this warrant a double bypass? Isnt his personal and family history enough to be more proactive with intervention? I was very close with my uncle and he passed away in his sleep just months after a normal cardiac exam. I dont want the same to happen to my dad, and Im concerned that hes heading towards a major event. Any insight? Am I right to want to push him to follow up on this immediately? Thank you.. ### Response: So obviously your dad has significant coronary artery disease. The family history at this point (which is ridiculously extensive) doesn't really matter since we know his anatomy.It looks like his left main coronary artery and left anterior descending artery (LAD) are open. His right coronary artery is blocked but past this it presumably backfills from the LAD through enlarged (collateral) vessels that wrap around the apex of the heart. This is why he had a positive stress test - with enough exertion the oxygen demand is too high for the left side to keep up.Almost all of the benefit for a coronary bypass procedure is with patients who have significant narrowing of the left main coronary artery or both of the immediate downstream arteries. These feed a large portion of the heart muscle, and not just your dad but anyone does poorly if they are blocked.However when these are open, which is the case here, the benefit is less clear and this is doubly true in the absence of significant symptoms. A left sided graft may not even stay patent in this setting, since there is competitive flow down the LAD. We would not usually do a bypass just for right coronary disease, the benefits do not appear to outweigh the risks in this scenario.The other blockages are being backfilled by the open arteries, and unless he develops new symptoms then medical management is at least as effective and safer. It isn't that the blockages aren't a concern, it is whether bypassing them is beneficial. In this case if it were my dad I would prefer aggressive medical management and lifestyle changes as much as possible..