4 Heart Caths Later

[jmike1_]

I am a 39yr old male, don't smoke, drink very little, and formerly exercised regularly.  However, I had high cholesterol, and a strong family history (Dad has had 14 angioplasties and 9 stents).  Chest pains started in early Feb, and eventually the doctors at Walter Reed (I'm active duty army) agreed to do a thalium stress test.  It showed ischemia and they did a heart cath on 8 Mar 06.  They found 80% blockage in my LAD in 3 places, and put in 3 stents.  I continued to feel bad and have similar sypmtoms. They did an echo cardiogram which showed nothing, and decided I might have reflux.  The symptoms persisted, and I had to call an ambulance in early April 06.  They found another 70+% blockage in the LAD between the uppper two stents they put in earlier, and added a 4th stent.  My sypmtoms did not go away, and the next weekend I again had to call an ambulance, and got my 3rd heart cath which was negative.  Two weeks later, I had to call the ambulance, and was admitted to Walter Reed.  The test for reflux was negative.  They decided to do another thalium stress test which showed mild septal ischemia, and they did a heart cath that afternoon.  The cath showed significant LAD disease which they couldn't treat with angioplasty because they were afraid of disecting the heart (very low in the LAD).  They are treating me with meds instead: plavix, baby aspirin, lipitor, niaspan, lisinopril, adalat, isosorbide mononitrate, and toprol.  My ?s: I still have pain - what is my longterm prognosis (heart cath every year?), I am scheduled to PCS to Romania in 07, is this safe?  Thanks!

[CCF-M.D.-MJM]

Hi jmike,

I am sorry to hear about your problems--you are too young for this.  You are on all the right medications.

Regarding your change of station, it depends on what you do.  I would not approve you to go into combat duty or anything that could cause stress or bouts of chest pain.  I have heard the army release people on medical disability for much less than this.  If you work at a desk job, I doubt this would be a big problem.

Prognosis is always a difficult one to speculate about.  You clearly need maximal medical management and risk stratification.  You should work aggressively with your doctors to do this.  Many times people your age will form new vessels to help perfuse the areas of your heart not getting enough blood but it is difficult to say for sure.

I hope this helps.  Good luck and thanks for posting.

[Marcus14006]

I am a 57 year old male, extensive family history of CAD on paternal side.  Father's first MI at age 39, followed by 5 more MI's, two CABG's, eventually succumbed to pancreatic cancer at 79.

I was diagnosed SVT 1981, controlled by Verapamil and Xanax.  I do have anxiety issues.

Fast forward to last summer.  June-2 stents to correct 2-90% blockages.  August-2 more stents to correct 2 new 60% blockages.  
September-stent #5.

Experiencing severe pain under the sternum.  A cat last month showed all 5 stents open.  Full bone scan "unremarkable".  CAT scan "unremarkable".  Seeing clinical psychologist to work on the anxiety end.  Next step is an upper/lower GI series to eliminate esophagus, stomach.

My bottom line appears to be that it is "all in my head", that my anxiety issues are controlling my brain, and I will have to live with the pain.  It really sucks because I was very active prior to the stenting, and have gained 15 pounds.  I walk a lot, carry a pedometer, get my 10,000 steps in on most days.

I just wanted you to know that when I saw your post, I immediately related to it.  Best of luck to both of us.  

I feel that I now live in some kind of time warp, and would love to get my old life back.  You are not alone.          

  

[jmike1_]

Marcus,
   Thank you very much for relating your story to me.  I wish I were alone and that no one else was going through this.  Don't necessarily think it's all in your head - there are so many small vessels and spots way down in the arteries that are tough to find.  A really low blockage in my LAD is my problem, and it took them 2 caths to find it (I was thinking it was in my head too).  Luckily, I have a great outlook and will not allow myself to get depressed.  As I said, I go to Walter Reed, and see the young men and women missing body parts from the war, and it makes me realize I just don't have it that bad.  Am hoping that the pain/angina will go away and I'll get used to it.  Until then, I guess my life will just be a little different.  Will say a prayer for you, and wish you the best!
Mike

[jmike1_]

Thank you for sharing your story.  I thought I was young, but my gosh - 29?  I'm so sorry you had to go through this even 10 years before me.  Best of luck to you and hope the doctors give you as clean a bill of health as possible.  Regarding your question, during my last cath they really went in and did a thorough look (2 1/2 hours) and checked at various points along my LAD to determine the pressure and to make sure that one of the stents wasn't for some reason blocking some of the flow.  During that check, they noted that one of my stents is blocking a side vessel, and I have significant blockage in my lower LAD, but the location makes it too difficult to treat w/ angioplasty.  They said the location of the blockage wouldn't kill me, but could certainly be the reason for my continued angina.  I'm just hoping that my body gets used to the lack of flow from that area, and the angina will go away.  Can't imagine feeling like this every day for the rest of my life.  BUT, then again, at least I'm still here and kicking. Again, best of luck to you and God Bless!
Mike

[NanaRose]

I too have very distal LAD ischemia.  They cannot stent this nor can they by-pass this...Too dangerous, I was told and it would restenose. They seem to think that the mid and upper LAD blockage caused the lower distal problems.  I was told the arteries are so small in that area...like micro.  I am on meds.
Have had 3 caths and 4 stents.

I want and need collaterals in that area. I wish you well.

[LukeL]

You have a very positive outlook on your situation. I too have many medical problems and have to tell my self that many people have it much worse then I do. I am not sure if bypass is an option for you, but doing some quick research I have discovered they have made many great advances in CABG in the past decade.

Hope everything works out for you, God Bless and thank you for serving.

[Healthyself2]

I don't normally comment on people that have been stented or bypassed and still have problems, because the dasterdly deed has been done, and you certainly aren't going to make them feel better by telling them that it was probably an inappropriate first solution for the problem they were having.

I don't think that doctors properly evaluate the risk when stenting, especially on young people.  Unfortunately, the problem with the current stents are that they are forever.   They are working on stents which will disolve over time, but they are years away from the market.

Problem is that, if you have an angioplasty, and they see any narrowing, they will stent it, forfeiting the chance for that artery to ever by returned to normal health.  And contrary to what cardiologists generally believe, coronary arteries can be returned to reasonably good health with agressive lipid medication, exercise, reasonable diet, and a few other lifestyle modifications.

The old sales pitch is always that you are at high risk of dying any minute, so they have to stent that artery or do bypass surgery.  Ain't so.  Risk can be greatly reduced in a matter of weeks.  Existing plaques can be stabilized to a point where the danger is minimal.

I do hope that you have no further problems with that artery.  A minimum invasive bypass using the mamary artery would probably be the next step, if there is a problem.

[Healthyself2]

Collateral vascularization is the heart's natural response to ischemia.

I have built a great collateral system around my 100% occlusion of the RCA over the years.  I've also not dropped dead from the ruptured plaque in my left main that I was told should have killed me by now.

I'm convinced that we do damage to the heart if we exercise through ischemia.  The trick is to learn where it begins and just push up against it every day.  To me it was like an old friend.  I knew exactly when my heart first encountered ischemia and would take a 30 second rest and them continue my activity as slow as necessary to gently push up against that threshold.

Over time you start pushing it back.  And that's probably because your network of capillaries is expanding around the blockage as well as your heart is getting stronger and more efficient.

It's funny, but after several years of progress and maintaining a perfect lipid profile through multiple medications, I have started backsliding and have got very fat this winter.  My alcoholism as also increased to a point were I drink every night.

I camped out for the weekend and walked about 6 miles Saturday with only 800' of elevation gain.  Took it pretty easy and felt no residual effect.

Today I went looking for a mine that I spotted from the other ridge yesterday.  I ended up climbing up over 1,000' on a very steep incline and ending up on top of some cliffs.  And all after a big breakfast.  I feel fine tonight.  1,000' is normally no big deal, and I have climbed over 4,000' feet in one day since my heart attack, but I am amazed that I still have such good ability.

I do expect that this could all come crashing down on me if I don't get back down to a decent weight, cut back the drinking, and start living right again.  But it is pretty amazing that after 5 years of getting my coronary arteries healthy again, I can abuse myself like I have, and still have good ability and not drop dead after doing something like I did today.

Good luck on building your collaterals.

[Marcus14006]

I know you prefer not to respond to people who are already stented and still having problems, but I have a question for you:  are you aware of any valid information out there relating to collateral arterial regeneration as a function of age?  I am 57.  Thank you.

[Healthyself2]

I'm 56 now and was 49 when I had my first confirmed heart attack.  I probably had my first heart attack in my early thirties when I laid in bed for 4 days with the same symptoms.

In my case, my first cath revealed a 100% occlusion of the RCA which was moderately collateralized.  My cardiologist believed that this blockage was longstanding, so the the collaterals must have been a response to the artery closing down over the preceding 15 years or so.

I had a second attempt at angioplasty a year and a half latter and the collateralization was now quite well developed.  My RCA just stops at a certain point.  From that point there is this large ball of capillaries which take the blood further down where the RCA seems to fill normally again.

What did I do in that year and a half?  I was very serious about recovering from my heart attack.  That first summer I hiked everyday as much as I was able and sometimes more than was wise.  Later when I went back to work I still walk a hilly 1.5 mile hike twice a day, rain or shine, and try to do more on the weekends.  I'm still trying to take the bulk of summers off, and hike and backpack as much as possible.

I know there are studies about injecting VEGF to promote collateralization, but I don't think anything has gotten to a point of being an approved procedure as of yet.

One thing for certain is that collateralization is a response to ischemia, at least in some or most people.  I personally think that the trick is to produce and sustain a very mild ischemic condition in your heart every day through medium to long duration exercise.  I developed a vision of pushing up against my old friend every day and eventually slowly pushing him back and that's what I did.

I did this by learning where my heart began to be ischemic.  I would walk uphill to just where I felt that and adjust my activity to be just under that threshold for two 30 minute sessions every day during the workweek and sometimes several hours on weekend hikes or skiing.

If I did too much, I would feel the after effects which seem to be inflamation (inflammation) of the heart muscle.  My goal was to do as much as I could and feel perfectly normal that evening. I think that exercising too far into ischemia on a regular basis is damaging to the heart.

There is some debate as to whether collaterals are existing capillaries which have expanded or new vascular growth.  I think the former, but am not an expert.  I do think that if your heart had time, it could revascularize the loss of all three major arteries to at least a minimal capacity, but that may be stretching it a bit.

As far as medications go, I don't know how much, if any, effect they have.  Unfortunately it took me a year and a half to get on an effective cocktail of lipid meds, mainly because the cardiologists where not really into that 7 years ago.  But I have kept a perfect lipid profile for at least the last 5 years, so perhaps that factors into the situation.

I've taken a bunch of supplements, but now only take a few. Perhaps follate and Vitamin E play some role, although studies say no.

Good luck with that and keep at it every day - the situation will improve.  But remember that it took several years to walk into the woods, so it will take several years to walk back out.

[Tudo1]

Interesting history you have there and thanks for sharing it. You mentioned alcoholism and I was wondering if you used that term loosely or if in fact you are ( or should be ) a friend of Bill W's ?

I had single bypass, mammary to LAD 14 months ago and went for a stress test 2 days ago. While on the treadmill the cardiologist remarked that the heart looks good and that the only thing slowing me down is my legs. I went on for the rest of the test and he called me today with the 2nd sentence starting with " I don't have good news for you, you have abnormal blood flow to the front of your heart, in the same area as where you were bypassed and we need to get you in for a heart cath to see what needs to be done and hopefully "fix" it". I have not had any symptoms . No chest pains, no nigt sweats, am reasonably energetic. I will see him this week but am also going to get another opinion and am calling C.C. to set an appointment. I'm 51, have not smoked in 18 months and this call today was a real shocker.

The surgeon who did the deed on me as you say, told me once and I don't believe it was in jest, that all that drinking of red wine prior to getting sober is probably what kept my blood flowing. While I have not ever seriously thought about drinking again, I have wondered.....

Thanks for reading.

Rgrds

[Tudo1]

I had an interesting conversation with someone who returned my call from Thailand today.

Not sure if anyone here has researched this stem cell treatment but I for one am looking into it. I had my first checkup at a hospital in Bangkok and was quite surprised at how modern the hospital is .

http://www.theravitae.com

Rgrds
Tom