blood clot in apex 16 mos. post heart attack

I am a 60 year old male post heart attack in LAD 16 mos. ago, and a stent was inserted.  This week I had a ct scan with dye. There was no new blockage or soft plaque, however there was a blood clot at the sight of the heart attack. My cardioligist said the clot is @ the sight of the damage, the apex. He said there is nothing that can be done because this far out from the MI the liklihood of the clot moving is very low.  I am concerned that there is a blood clot in my body, and I can't do anything about it, or shouldn't do anything about it. He said it can't be dissolved with medication. I am on Plavix, Lisinopril,aspirin, and just this week changed from Vytorin , after the bad publicity to Crestor. I am going to get a second opinion as soon as possible. I have a family history of heart disease and I am an avid excerciser. My lippids are excellent. In your experience how far out post heart attack have you seen this type blood clot? My concern is it's only 16 months. Should I continue to excercise as vigoriously. I have the utmost respect for my cardiologist and his treatment of my case, but I am anxious that there is nothing that can be done about a blood clot in my heart. Is this not more than enough reason to have open heart surgery?What do you suggest? Thank you.

[Lee Kirksey, MD]

Hello
I understand your anxiety. It is challenging for me to make detailed observations about your case without having all of the information of this complex sequence of events including the recent images from your CT. My guess is that there is a slight miscommunication about the location  of what you are describing as "clot". My first question would be to understand why you had a CT. Was there any clinical change in your health? I "guess" that what he meant by "clot" is that there is old hemorrhage in the heart muscle in the distribution of your LAD. I doubt very much that the clot is in your blood vessel or in the chamber of your heart. "Clotted blood" within the muscle of your heart can not safely beremoved without injuring your heart. This is likely in an area which was irreversibly injured in your heart attack and has been there since that time.

I always summarize a discussion with my patients by saying that "I am giving you a lot of information. Some of it may become confusing after you leave and go home and think about it. You may develop some questions and require further explanation. Dont hesitate to call if that happens"

I think in this case you may save yourself an unnecessary trip for a second opinion by consulting your cardiologist for a better understanding of why open heart surgery is not appropriate or necessary in this circumstance.

Good luck

[rs70]

I will now know better what questions to ask. Thank you.

[rs70]

By the way it was my choice to have the CT just to check the progress since the MI, no change in health.

[Lee Kirksey, MD]

Good luck. I think that with those questions, you'll get the answers that you need and save yourself the need to seek second opinion.

[rs70]

My Dr. called me Mon. to see if I had any questions, which was very kind. I asked him if it was a hemorrhage in the area of the MI. He explained that it was in the chamber of my heart and in his and his partners' experience, they had never had a patient with this condition, being this far out post heart attack, have complications with the clot moving.
However he said there are cases in literature that have. He said half of cardiologists would recommend Coumadin and half would not. He does not but left me on Plavix. My business partner in Atlanta has an uncle who is a heart surgeon from South Africa. So i will ask him to look at my ct unless you perform this service in your practice. Regardless thank you for your recent followup remarks. Regards.