43 yr old man with CAD and ICD with recurring restonosis

[kbowley]

In Oct 04 I woke to severe chest pain and called an ambulance (I have never had any issues with my heart) and was brought to the hospital. I was given several tests including nuclear stress, echos on my major vessels etc. i was released the next day and was told my heart was as good as a 20 yr olds (13 min on stress test) two days later it happened again, i drove myself to the hospital and proceded to have a v-fib arrest in the waiting room. I was urgently cathed and my RC was 95% blocked and required stinting of nearly the entire artery and my left circumflex was 100%. feb 05 i had another arrest and an ep study was done, I was told I was a "walking time bomb" and they put a st judes ICD in me the next day. I continued to have heavy chest pain, cathed in aug and was told everything looks great but the pain continued, sometimes so bad i would vomit. Finally I coudn't take it anymore and went to the ER 4 weeks ago and requested a certain DR to perform the cath. After he checked things over, he suggested open heart but i wasnt ready to make that decision doped up on morphine. He said he would try to open them up. My LC was 95% blocked in 2 spots, my RC had plugged back up completly and LAD was 95%. He told me i had the arteries of a 90 year old and the next time would definitly be open heart. I felt great for three weeks, better than I have in a year! Yesterday i began having pain again and it continues today. My lipids are fine and i walk on the treadmill 4 times a week.
My question is this, is everything being done that can be? is something being missed? help. Thank you.

[Cleveland Clinic]

kbowley,

thanks for the post. Youve been through a lot.

You seem to have an aggressive form of coronary artery disease. Its difficult to comment without actualy seeing your angiogram on what the best overall course for you is.  

With the reoccurrence of your symptoms you should seek evaluation locally. Once it is deemed stable you are probably going to be back in the surgery or angioplasty boat again.  There are a lot of factors that can make one option appear better than the other such as what the arteries look like (such as size, amount of calcium, location of the blockages) and what other medical conditions you have.

With your severe disease it might benefit you to seek a second opinion at a large tertiary heart referral center to look over all of your options. Also, a prevetive cardioloist might be helpful to make sure you are on all of the maximal possible medications to try to slow the process down.

good luck

[kbowley]

Thank you for your response Doctor. There wasnt enough room to post my current meds. I take the following; plavix 75mg, lipitor 80mg, tricor 145mg, toperol 100mg x2, lisinopril 5 mg, norvasc ?mg, asprin 325mg, zoloft 50mg, fish oil 3g, xanax 1mg 3x day. My weight is 185, of stocky build.
I have been to 4 different cardiologist for second opinions and have settled on my current one as the most caring, concerned and knowlegable. He is also a cardiac surgeon and has been for many years. He came from U-Mass and Boston Medical, he was also the head surgeon at the Layhey Clinic in boston. I feel very confident in his abilities.
I just cant believe, nor can I accept, that this is progressing this fast. I was just wanting for some hope or miracle drug that he may be missing. I would really like to live to see my daughter through high school (another 12 years) but the way things are going it doesnt seem to promising.
Is a visit to the CC waranted? Do you think that you may provide some treatment that i am not currently getting? I am willing to try anything at this point.

[Heart3]

Hi:  Sorry to hear your condition.  I wish you the best of luck with your current dr.  

I just wanted to mention that you might have to post your second question to the dr as a new question as I don't think they answer after they post to the lst question.  

Good luck

[tickertock]

Sorry to hear of your heart condition. Best of luck. Don't ever give up, pursue another opinion from CCF , the worlds best is there.I know others that their doctors had basically given up on them and they went to CCF and are now living practically normal productive lives. Good luck.

[Momto3]

You may want to look into CCF's second opinion program.  Check it out at:  http://cms.clevelandclinic.org/body.cfm?id=227&action=detail&ref=160

Your own doctor may well have you on the best course of treatment, but it may not hurt to get a second opinion.  You can even get a remote 2nd opinion.  You'll see the details by accessing the link.

Here's to an improvement in your health.  I hope you are able to see your daughter well beyond high school and into her old age.

Connie

[save]

I have 5 blockages and I will have to have surgery done shortly.  I have 2 that need stented and it can't be done because of where they are connected.  You have a much bigger problem, and I would go to the Cleveland Clinic.  It is the number one for heart in the country, and you will have doctors that are doing a lot of surgery,etc.  I am not saying that your doctor is not good, but you will have a team of doctors that do hundreds of procedures everyday. There are so many things that can happen and you want to be in a place where they have a lot of experience.

[rayg]

i know how you feel, i had 5 stents put in and then a double by pass. i had a heart attack after that due to a blockage in a stent they had just put in 3 weeks prior. the by pass looked like < on the x-rays, after the heart attack, the doctor wanted to stent it but it straightened itself out??????? i have chest pains alot but the doctor says everything looks good. it looks like to me the by pass is too long to look like a side way v. good luck......