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Subject: Re: Angina?heart failure I am a 53 year old malewith th following heart history: 1) M.I. Dec. 1984 2) Angioplasty at Cleveland Clinic April 1985 3) Attempted new angioplasty in a different on a different artery which ruptured resulting in emergency by-pass surgery on the one artery only in Aug. of 1986. 4) Since then I was doing relativley well exercising religiously and keeping to a very low fat diet. I did have some chest heaviness and shotness of breath when climbing stairs or doing work aroun the house. This made me very anxious and feel sick and it would last and it still does when I get it sometimes up to an hour or more. However, all the stress tests during this time (with the the exception of one) showed no ischemia. I have always been able to go 15 or 16 minutes on the Bruce protocal. Additionally, I am able to do my normal daily exercise routine of walking on the tredmill @ 3.6 mph with an elevationof 6% for 30 to 40 minutes. My heart usually gets to around 120 bpm. 5)In the summer of 1997 an avionics discovered some episodes of non sustained V-Tac.They did an angiogram which showed the by-passed artery to be patent but a questionable blockage in the L.A.D. They then did the angiogram with the trans? something where sound waves can examine the artery in question more closley. That showed no real blockage but the artery had difuse calcification along the entire length( they felt it was approximately one third narrowed.) They then tried me on LoPressor for afew days and then did the Eps test which "I failed" needing to be shocked back to normal. An implantable defibillator was installed in Aug.of 1997 which, thank the Lord has not yet fired. 6) Shortly after this I had another stress echo and my Ejection Fraction showed a decline to about 30-35% from arond 40% a year before. They then tried me on an ace inhibitor(vasotec) which gave me probable angio edema after about 3 weeks. I was then switched to cozar which again gave me an episode of throat tightness and they stopped it. So I have been on no med's other than Lipitor and aspirin. This is all backround to recent events starting a few weeks ago when I began having more frequent episodes of chest heaviness and shortness of breath on going upstairs and doing relativley light house work. In lightof this I just had anew stress echo. I went 15 minutes with no symptoms and results showed no ischemia. My ejection fraction was about the same ~35%.The only other facts I can think to tell you is that my resting heart rate is low ~50-60(most likley from my conditioning) and during sleep and at times during the day gets down into the mid 40's. After my Defib was installed they tried to keep me on the LoPressor but my H.R. was going into the 30's and the pacing device was continally working. Also I was very fatigued. Now finally, and I do apologize for going on so long, are my questions: 1)In light of my exercising without pain and the stress test results why should I have angina like pain when climbing stairs? Can this something else or related more to the fact that I have left vent. dysfunction? 2) With an E.F. of only 35% ,but being so sensitive to all med's, causes me concern for the right trade off. Is there a med, that wouldhelp reduce the risk of heart failure(I have no ankle swelling at this time,ect,)but would not slow my heart rate to such dangerous rates? 3)My internist is also concerned about my lipid protien little a., which is >100 and would like to see me go onto niaspan( I tried a fast acting niacin last year and had flusing and I thought some lip swelling. Should I give it another try, how important is little a ? My Ldl ie 89 and myHdl is 47 , overall cholestral is 160. Again I apologize for the length but would appreciate your advice. Thank you very much. --------------------------------------------------------------------------------------------------- Dear Tim 1. I can think of no good reason. I doubt it is related to the ventricular dysfunction. I hope this has been useful. Feel free to write back with further questions. Good luck. Information provided here is of a general nature. Specific diagnoses and treatments can only be made by your doctor. If you would like to be seen at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist at Desk F15. | |
