Question Title: CAD with Multiple Sclerosis

I am 49 and was diagnosed with Ms in 1982 and have it under control except of sever pain. I have an implanted morphine pump due to severe pain with MS. I was shocked to discover in 1997 that I had CAD and carotid artery stenosis of left and right arteries. To make a long story short I have CAD in every artery and vein. The neck arteries are 65% left and 70% right in neck. Highest % in heart is 70%. No one wants to operate on me. I am concerned about
having a stroke or serious heart attack. I am currently on Tiazan, Atenelol, Nitro Patch 4mg. I have angina on rest and sob at times. I want to know is my MS the reason why they do not operate and what happens if I need surgery with this implanted morphine pump. I feel like I have been given up on. Plus being a female with heart disease has been another issue I feel affects my health. I found as usual that a female complaining of chest pain is written
as needing more nerve pills. I just want an opinion as to you best guess as to why no one wants to help me surgically. I had chest pains for over 6 years and was constantly told it was in my head. What is it with doctors who think women are always mental. Hypothetically what would you do with a MS patient with a morphine pump, CAD, carotid artery stenosis, and just really sick in general. Thanks for your hypothetical answer. I am in need of some answers
the doctors I feel or not being honest with me and what they can and cannot do for me. I am a big girl and I know my situation. All is get is pats on the backs and sympathy what I need is an honest doctor to tell it like it is. Can I be helped or can I not. Thanks again I pray you have some thoughts on this hypothetical situation. You are very kind to help answer people's questions. I am grateful. Ms Brown

---

__

---

Dear Ms. Brown,
Any patient with other sources for pain is difficult to evaluate in regards to what and how much pain is actually due to the blockages in the coronary arteries. If such a patient has risk factors for coronary artery disease (blockages) usually the only way to find out and give appropriate treatment is to do a cardiac catheterization. What should follows a cardiac catheterization then is determining what would be the best approach for the blockages (if there are any), and this is determined by the number, positon, and character of the blockages. Then the cardiologist has to evaluate the clinical situation (patients pain, and other symptoms) to determine which treatment following catheterization would best address these issues and at the lowest risk to the patient.
For example, the major risk factors associated with angioplasty and coronary artery bypass surgery are heart attack, stroke, and death. Each patient must be individually assessed for the treatment that will provide them the most symptom (chest pain, shortness of breath, etc.)relief and yet the least possible risk for heart attack, stroke, and death. The patient should be involved in this decision making process considering that the options are continued medical therapy (often this includes the drugs that you are on such as beta blockers-atenolol, nitroglycerin, and aspirin), angioplasty, and surgery.
Because I do not know your full medical history and even if I had I could not even begin to surmise the thoughts of your physicians, remember that this Heart Forum is for informational purposes only and any diagnosis and treatment can only be made by your physician(s). Good advice for you is that if ever you want a second opinion, seek one, especially if you feel that the physician or medical personnel attending you is being dishonest. May be you just want a more detailed explanation of how the treatment plan for your care came about.
For women with carotid artery disease as well as coronary artery disease when blockages are severe and require dual surgery, there is not very much research just on women, however there is plenty of literature and debate regarding which surgery to do first or even if they should be done together. As for you, again ask your physician for the specific reasons why you are not having bypass surgery, including your need for intervention, risk of intervention, and most important if there is any thing you can do as the patient to reduce your risk of disease progression (blockages of the arteries is an ongoing process that starts in the teenage years).
Just to try to answer your question more specifically, if I had an MS patient with blockages of the coronary and carotid arteries, I would assess her risk for treatment of those blockages based on symptoms and degree of stenosis(how bad the blockages are)including possibly what is called a functional study such as persantine thallium. I would discuss potential risk with the surgeons who might perform the operation and the neurologists who might assist in management and risk assessment. One question that I would definitely want an anawer to is that should my patient need coronary artery bypass surgery, is there any increased risk of stroke or other neurological damage based on the underlying MS? You should Know that no surgery is without risks but surely going on cardiopulmonary bypass places significant strain on the whole body, but especially the brain.
An lastly, the reason why ther is debate about how to treat a patient with both carotid and coronary disease/blockages is that operating on the heart will place the patient at greater risk for stroke and vice versa. The question is always which surgery to do first and is there any benefit to doing the surgeries at the same time. The fact that you have MS just further complicates the picture, but does not make the decision impossible. I hope this information has been of some help to you and that you seek specific answers to specific questions that you have regarding your care.
Again, information provided in the Heart Forum is intended for general medical informational purposes only.

---