Heart Cath question

[Sissy45601]

I recently had this procedure done, and I was told that everything was fine, no problems other a slight increase in the amount of atherosclerosis. However, I do not think that I was told everything.

I requested a copy of the test results, and under PROCEDURES PERFORMED, it says something about a  "1ST Lesion Intervention:  FFR assessment of  OMI  60%  stenosis= .94  A       (blank)  was performed on the lesion in the 1st obtuse marginal."    What exactly is meant by "Intervention" here?  Also, under PROCEDURES PERFORMED, this was mentioned:  Diagnostic myocardial fractional flow reserve.  What is this?

Under  IMPRESSIONS:   (Diagnostic)  Normal LVEDP, Normal LV function, 40%  mid LAD stenosis, 40%  mid RCA stenosis,  and 60%  stenosis of the OMI of the Circumflex.
Under  RECOMMENDATIONS:   Continue medical management for moderate coronary artery diseae and risk factors modifications.  Is this the same as atherosclerosis?  I think that it is more what my Mother had, and my Brother has.

I would like to know if I should have been advised of the things mentioned here, and/or  if I should be concerned.  It is so annoying to have tests done, be told "Everything is fine", then request a copy of the test results and see these things that don't exactly look "Fine" to me!  My Mother had 2 open-heart surgeries, and my Brother has had numerous stent surgeries, and just recently had a triple bypass done.  You can see why I am concerned.

Thank You for any information that you might be able to provide.

[Sissy45601]

I appreciated your input, but you need to know that it just so happens that I know all about ejection fractions. Unfortunately our son has an EF of 15%. He is 45, and it was discovered when he was 41.  He has a difibrilator/pacemaker, and is on a lot of medication, but he strong willed. On the subject of atrial fib, I have that condition myself, and have had it for several years. I take atenolol every day.

So, I have quite a bit of "education" regarding conditions of the heart. With all of the heart surgeries that I experienced with my parents and brother, and what I am still experiencing every day with my son's chronic heart condition, I have learned a lot. However, it is not possible for me or any other non-medical person to understand what is on a heart cath test result such as the one that I described in my opening post.

I could say a lot more here, but I will just say again that I believe that doctors can do better with regard to informing their patients of their conditions in terms that are in a language that is understandable. This is their responsibility!

[Flycaster305]

I agree with much of what has been posted here.  However, I think you need to know that you have received a pretty clear warning.  You have stuff building up in your arteries.  I got the same warning when I was in my 50's and basically ignored them, and paid a heavy price.  Keep in mind, dirty pipes in your house plumbing plug up faster than clean ones, so now is time to take the cholesterol medications, aspirin, etc as prescribed, and above all, get at least 30 minutes of aerobic exercise daily.  Your pipes, in my opinion, are pretty dirty, I'm sorry to say.  
I'd worry less about non-communicative doctors and educate yourself as much as you can.  This site has people that can help you understand things like ejection fraction, blockage percentages, blockage location dangers, etc. We can't change non-communicative doctors, but we can educate ourselves.  Every time I have a procedure, and like ed34 I've had a lot of them with countless angiograms, eight stents, a pacemaker and bypass surgery, I get the procedure report and study it carefully. You would be amazed at how doctors change their explanations when you talk about 'ostial' blockages, heart efficiency, A-Fib issues, etc.   I'm convinced that by learning and being a part of my recovery is why I'm still walking on the sunnyside of the earth.  
Keep us informed.

[RubyWitch]

I totally agree with you, ed. I have said it a couple times that we, as patients, are not stupid, but most of us do not have advanced degrees as diagnosticians. We could, and I believe, should be given the original report, but attatched should be a thorough explanation of what each and every  part of that report says in language we can understand. As patients we should also be told that some test results will take longer than others. Many people, especially the elderly, don't always understand that the technician doing the test is NOT a doctor & is not qualified to interpret the test results. (Even tho an experienced tech WILL be able to tell if there is an anomoly, they are not allowed to say anything to the patient.) It then goes to a doctor who is trained to interpret what he sees, he/she then writes a report to the attending physician. It is then up to THAT doctor to explain to us in words we understand, exactly what the results mean.

I think medical schools need to add one more very important class to a young doctors training and that would be focused on retaining their compassion for those of us on the other side of the stethascope.  

[ed34]

With Nuclear scans there is a waiting time for results, the Doctor has to study the images and interpret them, then write a report for the Doctor and Cardiologist. I don't think a patient should receive the results, it should be explained in plain language by the Doctor. With Angiograms the results, are known immediately, and I think they should employ someone to sit with the patients after the scan to explain everything and answer questions. This saves the patient waiting and being afraid. EKG and Echo scans could be explained closer to the time of the too, how long does it take a cardiologist to look through the results.  

[RubyWitch]

I'm sure some doctors DO keep things from their patients if they feel the patient can't handle the information at that time. And in SOME cases, I would probably even agree.
Because I work in a hospital, on a surgical unit, I interact with surgeons daily. While I have the utmost respect for their craft.........what I would even call "artistry" in some surgeons with respect to their skills in the OR, they are notorious for their mind-boggling lack of people skills.
It's my belief, based on what I overhear them talking about amongst themselves, is not so much that they withold info to spare US any angst, but to spare THEMSELVES wasting time "trying" to explain that which we mere mortals could never hope to grasp.
Perhaps it IS my exposure to surgeons that makes them dread walking into my room after they've sliced and diced me. If they think they're going to dazzle me with some medical mumbo-jumbo then scarper out the door, they're in for a bit of a surprise. I believe my questions and concerns deserve their full attention and complete explanations and if that means they miss T-off time at the club, well, they can hand me their "Tough S**T" ticket and I'll be happy to punch it...........AFTER every one of my questions has been answered.

Oh my..............do I sound a hair jaded?

I'm sorry for all the health problems your family has endured. You do indeed have quite the history, you could probably write a book. I would strongly urge you to do so with all you have learned the hard way.

We will BOTH be fine, Sissy and if you're ever in Seattle, I'll take you out for a dinner piled sky high with fat and we'll thumb our noses at the "great ones!"
You in?
Peace
Greenlydia  

[Sissy45601]

Thank you so much. Your words are very encouraging, and YES,  Ed was also very helpful. I wish that I could understand why doctors are so bad about keeping info from the patient. I wonder if it is because they think that the patient can't handle it?  Well, NOT so for me, and you are right, it IS very disrespectful and demeaning, among other things.

I know that it is important that I watch the signs and make sure that I get the regular screenings. I am not a stranger to heart attacks and blockages. My family has quite a history.

Unfortunately, my Mother had 2 open heart surgeries due to a heart attack, and  major blockages,  my Father had 1 open heart surgery due to 100% blockage in main artery, and my Brother has had 5 stents, and just had a triple bypass due to major blockages.

I WILL be fine, and I thank you again.
Sissy

[RubyWitch]

We are very lucky to have ed34 helping us understand what our cardiologists seem unable to explain in terms that "dunderheads" can comprehend. LOL

I'm sure what he has told you has helped you not only understand all the "doctor-speak," but has helped you to relax about those results.

As the proud "owner" of two nifty stents in MY coronary arteries, trust me,  I can relate very easily to those incomprehensible reports which scare the bejezzus out of you!

Your 60% may sound very frightening to you, just keep in mind his analogy of the 12 lane highway. You've still got a ton of wiggle room and with some lifestyle changes, it's entirely possible, even likely, you'll never see another cath lab in your life.

My blockages were at 95%+ and >90%. For me, it's nothing short of a miracle I even made it to the cath lab.

Ask your cardiologist if he will refer you to a "Cardio Rehab" program, which should be covered by your insurance. I think you should qualify. At 58, I was the youngest person in the class, but Lordy did we have fun!

Before I go, I'd also like to say that it is your right as a patient to have every single procedure and test.........and the results of those procedures and tests, explained to you in language you understand and all your questions answered even if you have to ask them 10X. NEVER let a doctor tell you that YOU really don't need to know what something means........that is arrogance at it's worst, disrespectful, demeaning and unacceptable. We may not be thoracic surgeons, but neither are we stupid.  While ed undoubtably helped you understand a great deal about your test results, you should not have had to write to a CAD forum to have your questions and concerns answered. Those should have been addressed by your cardiologist. Sorry for the rant, I work in a hospital and I swear, I spend most of my day explaining to patients what the doctor who just flew in and out of their told them.

You're gonna be just fine. You know you have some blockage now, you know how to keep it under control and I'm sure you'll be seeing your cardio for regular screenings so that any problem will be caught in plenty of time.

Now, get out there and rake those dang leaves!
Peace
Greenlydia      

  

[ed34]

Hi,  Confusing isn't it, but I will try to help you with the little knowledge that I have. I don't think they have done any actual intervention, such as stenting, because the blockages are not large enough yet to warrant this. Believe me, if you have a 60% blockage and they stent it, you 'could' end up worse off because scar tissue may grown inside the stent quite quickly, even blocking it totally. So intervention is left as late as possible.
The FFR fractional flow rate, or sometimes called fractional flow reserve is a tiny sensor on the end of the catheter. It measures blood flow and pressure at the sensor. I commend your Cardiologist for using this device, hardly anyone does. They take a base reading at the top of the artery where there is no disease, then slowly move the sensor down. They look for any drop off, where the pressure/flow drops significantly. This is a sign of a problem with the artery lining, such as a blockage, inflammation or damage. It looks like the drop off at the other side of your blockage was very little, meaning the 60 % is of no concern yet. This is why they've recommended you stay on medication only. Imagine your coronary arteries as 12 lane highways. They are much wider than they need to be for the amount of traffic. You can close 6 lanes and still comfortably get the traffic through. Your arteries can be blocked at 50-60% with no effect because they are bigger than they need to be. 40% is nothing although is sounds a lot. If your Atherosclerosis has worsened, then I would look at your risk factors and see what room for adjustment you have. For example, the classics are, no smoking, healthy diet, regular exercise, low emotional stress, keep blood pressure normal, keep blood cholesterol low even if it requires statins.
Newer research is suggesting to keep processed sugar intake to an absolute minimum, such as soda drinks.
I hope this helps in some way.