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Heart Disease (Expert Forum)
DX a heart attack and Plavix Question
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve, Pacemaker, PAD, Stenosis, Stress Tests
DX a heart attack and Plavix Question
by MaryRoe, Jan 14, 2006 12:00AM
Thank you for taking my questions.
3 years ago an EKG showed an MI. Cardiologists said leads were placed wrong.. All Subsequent EKG's showed the same MI except one. Always told leads were placed wrong or it was my anatomy. Angina pains continued. Cardiac Cath did not show a heart attack..only an area of severe plaque in distal LAD that could not be stented or bypassed. Mid LAD stented. Mid RCA stented.
Told again no MI and go about my business. I asked for a Cardiac MRI. This did show the MI in the distal LAD.
Question: Why doesn't a Heart Cath show a heart attack? Doesn't this give patients a sense of false information unless they resort to a Cardiac MRI?
Question: How long must one be on Plavix to keep coated stents open? I need knee surgery badly and need to be off Plavix for 5 days prior to surgery. Cardiologist has vetoed all surgery.
I have 3 stents and with 2 of the stents, I have been on Plavix for 15 months and the last stent..on Plavix for 9 months. What is Cleveland Clinics thoughts on this?
Question #3. Recent CT scan of chest shows calcification in the Lad and mid RCA. (had this scan looking for pneumonia) I thought once an area was stented..these arteries were cleared. Does calcification remain after stents? How can one get rid of this calcification?
Question #4. How does one tell if collaterals are growing?
Thanks doctors for your time in answering these.
3 years ago an EKG showed an MI. Cardiologists said leads were placed wrong.. All Subsequent EKG's showed the same MI except one. Always told leads were placed wrong or it was my anatomy. Angina pains continued. Cardiac Cath did not show a heart attack..only an area of severe plaque in distal LAD that could not be stented or bypassed. Mid LAD stented. Mid RCA stented.
Told again no MI and go about my business. I asked for a Cardiac MRI. This did show the MI in the distal LAD.
Question: Why doesn't a Heart Cath show a heart attack? Doesn't this give patients a sense of false information unless they resort to a Cardiac MRI?
Question: How long must one be on Plavix to keep coated stents open? I need knee surgery badly and need to be off Plavix for 5 days prior to surgery. Cardiologist has vetoed all surgery.
I have 3 stents and with 2 of the stents, I have been on Plavix for 15 months and the last stent..on Plavix for 9 months. What is Cleveland Clinics thoughts on this?
Question #3. Recent CT scan of chest shows calcification in the Lad and mid RCA. (had this scan looking for pneumonia) I thought once an area was stented..these arteries were cleared. Does calcification remain after stents? How can one get rid of this calcification?
Question #4. How does one tell if collaterals are growing?
Thanks doctors for your time in answering these.
Doctor's Answer
by CCF-M.D.-MJM, Jan 14, 2006 12:00AM
Hi Maryroe,
Good question.
Why doesn't a Heart Cath show a heart attack? Doesn't this give patients a sense of false information unless they resort to a Cardiac MRI?
It is possible to have an acute clot form and disolve leaving no evidence of blockage yet still causing an MI. We know that some people tend to have clot formation, some people get atherosclerosis (blockages) with no clots and other people get both. 100 years from now we will know a lot more. When I see a heart cath that shows coronary artery disease, I treat them like they have had a heart attack with maximal risk reduction. It most cases this catches everyone, including yourself. There is a sub population usually in young people that can have a heart attack with an acute thrombus that completely resolves leaving no evidence of blockages. These cases are difficult, but ultimately should be treated like coronary artery disease. I seldom use MRI's to confirm previous heart attack. I use them to show hibernating tissue to help decide if someone will benefit from a surgery.
Question: How long must one be on Plavix to keep coated stents open? I need knee surgery badly and need to be off Plavix for 5 days prior to surgery. Cardiologist has vetoed all surgery.
I have 3 stents and with 2 of the stents, I have been on Plavix for 15 months and the last stent..on Plavix for 9 months. What is Cleveland Clinics thoughts on this?
I think the overall recommenedation is a 3-6 months depending on if it is a taxus or cypher stent, but we usually try to keep people on it for atleast a year, sometimes indefinitely. This is an area that we need to learn more about. I would also be hesitant to recommend coming off plavix for an elective surgery. These are difficult situations with no one correct answer.
Question #3. Recent CT scan of chest shows calcification in the Lad and mid RCA. (had this scan looking for pneumonia) I thought once an area was stented..these arteries were cleared. Does calcification remain after stents? How can one get rid of this calcification?
There is no way to get rid of calcification. Calcification remains after stents. It is important to remember that stenting only relieves symptoms of angina or anginal equivalent, it does not effect mortality or the pathophysiology of coronary disease. This is why it is important to stay on your statin, asa, plavix and other cardiac meds.
Question #4. How does one tell if collaterals are growing?
You can't. Caths will show it, but there is no other way to know and I would never order or do a cath evaluate for collaterals.
I hope this helps. Thanks for posting.
Good question.
Why doesn't a Heart Cath show a heart attack? Doesn't this give patients a sense of false information unless they resort to a Cardiac MRI?
It is possible to have an acute clot form and disolve leaving no evidence of blockage yet still causing an MI. We know that some people tend to have clot formation, some people get atherosclerosis (blockages) with no clots and other people get both. 100 years from now we will know a lot more. When I see a heart cath that shows coronary artery disease, I treat them like they have had a heart attack with maximal risk reduction. It most cases this catches everyone, including yourself. There is a sub population usually in young people that can have a heart attack with an acute thrombus that completely resolves leaving no evidence of blockages. These cases are difficult, but ultimately should be treated like coronary artery disease. I seldom use MRI's to confirm previous heart attack. I use them to show hibernating tissue to help decide if someone will benefit from a surgery.
Question: How long must one be on Plavix to keep coated stents open? I need knee surgery badly and need to be off Plavix for 5 days prior to surgery. Cardiologist has vetoed all surgery.
I have 3 stents and with 2 of the stents, I have been on Plavix for 15 months and the last stent..on Plavix for 9 months. What is Cleveland Clinics thoughts on this?
I think the overall recommenedation is a 3-6 months depending on if it is a taxus or cypher stent, but we usually try to keep people on it for atleast a year, sometimes indefinitely. This is an area that we need to learn more about. I would also be hesitant to recommend coming off plavix for an elective surgery. These are difficult situations with no one correct answer.
Question #3. Recent CT scan of chest shows calcification in the Lad and mid RCA. (had this scan looking for pneumonia) I thought once an area was stented..these arteries were cleared. Does calcification remain after stents? How can one get rid of this calcification?
There is no way to get rid of calcification. Calcification remains after stents. It is important to remember that stenting only relieves symptoms of angina or anginal equivalent, it does not effect mortality or the pathophysiology of coronary disease. This is why it is important to stay on your statin, asa, plavix and other cardiac meds.
Question #4. How does one tell if collaterals are growing?
You can't. Caths will show it, but there is no other way to know and I would never order or do a cath evaluate for collaterals.
I hope this helps. Thanks for posting.
I was not aware that there was a difference in Plavix Time between the Taxus and the Cypher. Yes, the cardio doctor said lifetime for the Plavix but I must be on Plavix for at least one year for all stenting. I am avoiding complaining about anything (heart related) as I do not want another Cath or another stent. I need this surgery.(fell off a threadmill and tore a ligament and hair line fracture in the knee cap) I am having a hard time doing much.
As far as the Cardiac MRI goes, the heart cath doctor bet that an MI would not show up on the MRI as he said I did not suffer one. I suspected that I did have one, sometime. (woman's intuition) He lost the bet. It showed regional wall abnormality specifically in the distal half of the interventricular septum and the apex are severely hypokinetic/akinetic. Viability/scar imaging reveals transmural/near transmural scar in the distal half of the septum as well as in the apex. Also, there is dynamic LVOT gradient due to SAM. I was told this area could not be stented or by-passed as the vessels are too small due to being a female. This is why I am very interested in growing collaterals.
Thank You again, doctor. Yes, you have been a big help.
I am avoiding this like the plaque (-: as I fear I will have an agressive doc that will want to do another stent...LOL (feel the last stent was not necessary)
Another stent means another year on Plavix and another year of knee pain that needs surgery desperately. I wonder how people on Plavix due to stents, have any type of surgery. Last week, the Cardio doc vetoed getting a tooth pulled but my DDS and Oral surgeon said it was so decayed that this in itself can hurt the heart, so they pulled it. They told me to continue the Plavix. I did. They did not stitch the area thus avoiding more bleeding. I did great. In fact this was the first time I hardly bled with getting this molar pulled. The other 2 times, I was not on Plavix and I bled a lot more. Maybe the "no stitches" this time was the factor. I was not given any Epherinphrine..only a shot of Carbocaine and I did well.
Have a nice day.
Yes, getting a good Cath doctor is like winning the Mega Millions. The first one I had....well......he was more interested in himself and another collegaue than me. I nearly had by-pass surgery