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Angiograph or Special Diet
In November 1995 after I had mild discomfort of chest I had an angiogram done which showed 70-75 of LAD blockage. Doctor said I was borderline for angioplasty so I chose to go on strict diet and excercise regimen. I am very active, play tennis once a week and do 30 minutes treadmill daily at 3.6 MPH. I made great progress for 4 years and yearly had a Thallium Treadmill Test and all was found normal in years 1997,98,99,2000, 2001 (did not get chest tightness). In June of this year ONLY when I go for my early morning walk I again get tightening of chest which disappears as soon as I am back inside the house. I went to see my cardiologist and he suggested I get an angiogram done again. My question is : I would like go back on an aggressive no fat diet and excercise and see if I can get rid of the morning chest pains within next 3 months, then first do a Thallium test again and ONLY if Thallium test shows a problem do an angiogram. What do you think ? Is it worth doing an angiogram when the Thallium shows normal and I can do so much severe activity as go 30 minutes on treadmill and play couple of sets tennis with no problems ? Thanks.
hi subashnanda, you might find my story similar to yours in that i can do intense exercise (dancing) to the point of heart absolutely pounding (i'm 50) without any angina or anything like it. yet most of the time now i go through the day with a dull ache in the centre of my chest (below the sternum) that makes me think "oh - oh, heart....". nothing wrong with the heart, of course, so it must be the arteries (it ain't heartburn!). i'm no doubt paying the price for an atrocious diet when in my 20's (sugar/junk food addict). i don't consult doctors coz i don't really care to know exactly what's going on inside; even if it's true, their observations and advice can scare you into a depression. i figure if God wants me to pay the price for a poor diet (it's good now), i'll pay it. no doctor is gonna open me up and do anything, coz doctors have no right to interfere with nature, and i am part of nature. if the diet i'm on now (vegetarian, raw food, no fish/meat/eggs/dairy) can't reverse whatever happened, then God can shorten my life or take me out. for 33 years i was a "vegetarian" (no meat or chicken) with fish, eggs, dairy allowed. i'm starting a grand raw food experiment, and will eat like i've been stranded on a desert island, no stove. a natural diet. i believe that calcium deposits in the arteries come from the inorganic calcium in flour products (which i have eliminated) and cooked rice/grains. i've eaten lots of cooked rice. now i'll be having rolled oats (in muesli with fruit and nuts) only for carbs. good luck with your diet. i hope you report on the results. thanks for listening.
Don't know if you are aware of a newly FDA-approved therapy for angina... It's called Enhanced External Counter Pulsation - EECP for short. Anecdotal evidence so far very encouraging.
Correction: That's a 100% occlusion of the RCA - but you don't need much of the right side of your heart anyway :)
The chest pain that you are now experiencing in the mornings sounds like classic angina to me.
A year ago, I would eat a bowl of cereal and go out and walk the dogs at daybreak. After about 100 meters, I would get angina in the center of my chest. If I rested and walked slowly, after about 15 minutes, I would feel normal enough to continue my walk at a normal pace.
An Angiogram showed that the intima of my left main had "cratered" - that is a plaque had ruptured and the cap was gone, leaving the shoulders of it fluttering in the bloodstream. This problem had not even shown on the angiogram 2 years before. Fortunately, I survived it - blowing out a major plaque in the left main kills a lot of people.
I worked out of that severe angina in about 3 or 4 months but am convinced that the problem is still there. I still have a problem if I don't do a slow warmup or I eat before strenous exercise. But I can't run more than a few minutes or play tennis like you do.
If you are not sure, eat something substantial, wait 15 minutes, and go out and walk up a steep hill for a few hundred meters. If you have a problem, that should trigger the angina.
A person can have great exercise tolerance, even with 90% blockages. I climb Washington State's second highest mountain every year and I have a 100% occlusion of the left main, a 90% occlusion fo the circumflex, and about a 70% obstruction of the left main at my last angiogram. I pack a 55 lb backpack for 8 or 9 hours a day, up and down several thousand feet, for weeks at a time. I also did that at 10,000 feet elevation for a week last September. I think that's unusual for a guy, who every doctor that has ever treated him has recommended immediate bypass surgery.
It sounds like your cholestorol numbers are very good, but Lipitor would still help, if you don't have liver problems.
Also with your good habits you may have stopped the disease and be able to regress whatever is causing that morning angina over time. You may not be at as great of risk as the guy who weighs 240, has a TC of 220, and an HDL of 29 like I used to be. But if you do have an MI in that left main, it's going to damage a lot of heart muscle, and it's probably worth having a cath to really see what the situation is.
It's a hard call. I don't like messing up my femoral artery for no good reason. I also am glad that I don't have any steel in my arteries or any grafts in them - but perhaps a stent in a blockage in the left main is the best alternative in some cases. Also a single artery minimal invasive, off pump bypass, with the mamary artery to the left main, is probably a relatively easy surgery, if you were to come down to that in the end.
But it is good to get the best assessment of the situation. I don't make any decisions when I'm flat on my back in the hospital, and that's when these guys like to make the sale on dropping a stent or taking you upstairs for bypass - so you do have to watch out.
With me, I'm just taking it 1 year at a time and working my program - meds, exercise, diet, supplements, and daily attitude adjustment. If it get's down to a matter of life or death, or I loose my physical capability, I will probably go for bypass surgery and hope for the best. But perhaps I have stopped the disease and can reverse it over time.
Best of luck to you and happy holidays.
A year ago, I would eat a bowl of cereal and go out and walk the dogs at daybreak. After about 100 meters, I would get angina in the center of my chest. If I rested and walked slowly, after about 15 minutes, I would feel normal enough to continue my walk at a normal pace.
An Angiogram showed that the intima of my left main had "cratered" - that is a plaque had ruptured and the cap was gone, leaving the shoulders of it fluttering in the bloodstream. This problem had not even shown on the angiogram 2 years before. Fortunately, I survived it - blowing out a major plaque in the left main kills a lot of people.
I worked out of that severe angina in about 3 or 4 months but am convinced that the problem is still there. I still have a problem if I don't do a slow warmup or I eat before strenous exercise. But I can't run more than a few minutes or play tennis like you do.
If you are not sure, eat something substantial, wait 15 minutes, and go out and walk up a steep hill for a few hundred meters. If you have a problem, that should trigger the angina.
A person can have great exercise tolerance, even with 90% blockages. I climb Washington State's second highest mountain every year and I have a 100% occlusion of the left main, a 90% occlusion fo the circumflex, and about a 70% obstruction of the left main at my last angiogram. I pack a 55 lb backpack for 8 or 9 hours a day, up and down several thousand feet, for weeks at a time. I also did that at 10,000 feet elevation for a week last September. I think that's unusual for a guy, who every doctor that has ever treated him has recommended immediate bypass surgery.
It sounds like your cholestorol numbers are very good, but Lipitor would still help, if you don't have liver problems.
Also with your good habits you may have stopped the disease and be able to regress whatever is causing that morning angina over time. You may not be at as great of risk as the guy who weighs 240, has a TC of 220, and an HDL of 29 like I used to be. But if you do have an MI in that left main, it's going to damage a lot of heart muscle, and it's probably worth having a cath to really see what the situation is.
It's a hard call. I don't like messing up my femoral artery for no good reason. I also am glad that I don't have any steel in my arteries or any grafts in them - but perhaps a stent in a blockage in the left main is the best alternative in some cases. Also a single artery minimal invasive, off pump bypass, with the mamary artery to the left main, is probably a relatively easy surgery, if you were to come down to that in the end.
But it is good to get the best assessment of the situation. I don't make any decisions when I'm flat on my back in the hospital, and that's when these guys like to make the sale on dropping a stent or taking you upstairs for bypass - so you do have to watch out.
With me, I'm just taking it 1 year at a time and working my program - meds, exercise, diet, supplements, and daily attitude adjustment. If it get's down to a matter of life or death, or I loose my physical capability, I will probably go for bypass surgery and hope for the best. But perhaps I have stopped the disease and can reverse it over time.
Best of luck to you and happy holidays.
Thanks for your comment, but that is exactly what is baffling me. I am able to do lengthy periods of aerobic activity without angina or getting out of breath. As for LDL/HDL, I have reduced total Cholestrol to 170, LDL to about 78 and HDL to 50, so all these are pretty good. I am not overweight at all, weighing in at 150 lbs for 5 ft 8 ins height. Currently I will wait another 3 months and aggressively pursue a low fat diet and excercise regimen. I have also become a vegetarian which helps.
Hi subashnanda,
I don't think that they will reply to your second question. In my experience, you can be pretty far gone an still have a lot of exercise capability.
I have a 100% occluded RCA, about an 90% ostial occlusion of the circumflex and a large "cratered" plaque in the left main. I don't play tennis, but I climb Mt. Adams (12,300') every year, and backpack for a week at a time carrying up to 55 lbs. A couple of weeks ago I hiked 11 miles in about 5 hours and went up about 2,000' and back down. I don't do highly aerobic exercises like running more than a few minutes or playing tennis, however.
From what I understand a blockage of the LAD is particularly dangerous, because a heart attack there will damage the most important muscle in the heart.
A friend, who has a lean body mass, decent cholesterol numbers, and is fit noticed some angina when x-country skiing. Had an angioplasty and they discovered a single blockage in the LAD. They put in a stent and he seems to be fine and didn't have restinosis. Also a single blockage in that artery is a good candidate for a mininal invasive bypass using a mamary artery.
Not having it stented or revascularized has a good deal of risk. In my particular case, A year ago I was given a 40% chance of sudden death within 5 years. The problem is that I don't have a stentable blockage and only have the option of a multiple bypass.
You have accomplished the most difficult thing that any heart patient can do - live life on a low fat diet. I have a "lower than before" fat diet, but I depend on drugs to get my lipids in order. I use a combo of Niaspan + Lipitor + Welchol. My TC has come down from 220 to 141. My LDL is down to 78 and my HDL has increased from 29 to 48.
I don't know what your lipid numbers are, but there have been several studies by a Dr. Greg Brown here at the University of Washington that have shown that the combo of Niaspan + a statin basically stop atheriosclerosis in it's tracks and return some people to normal within 5 years.
A low fat diet and lean body mass are the most important things that you can do, but if your numbers are still not optimal, the drugs are the way to go.
I don't know what I would do if I were in your place. Perhaps I would take a stent - the LAD is a good place to stent. But stents are forever. It's a piece of metal in your artery and your arteries are not meant to have metal in them. After that sometimes its only a matter of time, but perhaps a long time, before you need their next procedure.
I'm taking it one year at a time. Do my up and down walks for 30 minutes before work and before lunch. On the weekends, I hike, climb, or ski.
When you have severe blockages you can still do a lot, but you need long slow warmups and you can't eat before exercise. I could probably work my way up to playing tennis, but I would have to warm up for about 20 minutes before playing.
Having an angiogram is stressful to the body and it messes up your femoral artery for a few weeks. I don't like taking a chance on damaging that artery because I depend on my legs for life. But you can probably do it a few times without adverse long term effects. Problem is that once they are in there they will probably drop a stent in you whether you like it or not.
Well good luck to you.
I don't think that they will reply to your second question. In my experience, you can be pretty far gone an still have a lot of exercise capability.
I have a 100% occluded RCA, about an 90% ostial occlusion of the circumflex and a large "cratered" plaque in the left main. I don't play tennis, but I climb Mt. Adams (12,300') every year, and backpack for a week at a time carrying up to 55 lbs. A couple of weeks ago I hiked 11 miles in about 5 hours and went up about 2,000' and back down. I don't do highly aerobic exercises like running more than a few minutes or playing tennis, however.
From what I understand a blockage of the LAD is particularly dangerous, because a heart attack there will damage the most important muscle in the heart.
A friend, who has a lean body mass, decent cholesterol numbers, and is fit noticed some angina when x-country skiing. Had an angioplasty and they discovered a single blockage in the LAD. They put in a stent and he seems to be fine and didn't have restinosis. Also a single blockage in that artery is a good candidate for a mininal invasive bypass using a mamary artery.
Not having it stented or revascularized has a good deal of risk. In my particular case, A year ago I was given a 40% chance of sudden death within 5 years. The problem is that I don't have a stentable blockage and only have the option of a multiple bypass.
You have accomplished the most difficult thing that any heart patient can do - live life on a low fat diet. I have a "lower than before" fat diet, but I depend on drugs to get my lipids in order. I use a combo of Niaspan + Lipitor + Welchol. My TC has come down from 220 to 141. My LDL is down to 78 and my HDL has increased from 29 to 48.
I don't know what your lipid numbers are, but there have been several studies by a Dr. Greg Brown here at the University of Washington that have shown that the combo of Niaspan + a statin basically stop atheriosclerosis in it's tracks and return some people to normal within 5 years.
A low fat diet and lean body mass are the most important things that you can do, but if your numbers are still not optimal, the drugs are the way to go.
I don't know what I would do if I were in your place. Perhaps I would take a stent - the LAD is a good place to stent. But stents are forever. It's a piece of metal in your artery and your arteries are not meant to have metal in them. After that sometimes its only a matter of time, but perhaps a long time, before you need their next procedure.
I'm taking it one year at a time. Do my up and down walks for 30 minutes before work and before lunch. On the weekends, I hike, climb, or ski.
When you have severe blockages you can still do a lot, but you need long slow warmups and you can't eat before exercise. I could probably work my way up to playing tennis, but I would have to warm up for about 20 minutes before playing.
Having an angiogram is stressful to the body and it messes up your femoral artery for a few weeks. I don't like taking a chance on damaging that artery because I depend on my legs for life. But you can probably do it a few times without adverse long term effects. Problem is that once they are in there they will probably drop a stent in you whether you like it or not.
Well good luck to you.
Thanks for your input. Is it really possible to do the kind of strenuous excercise I do (play tennis for 1.5 hours, do treadmill for 30 minutes at 3.7 mph) with a serious blockage ?
Dear subashnanda,
Given your history and symptoms I would probably recommend going directly to angiogram. Thallium is OK but it can be wrong. The big difference between now and 1995 is the presence of symptoms. If the blockage has progressed then the next best step is probably angioplasty. Diet and exercise are important also but should not stop you from taking other treatments also.
Given your history and symptoms I would probably recommend going directly to angiogram. Thallium is OK but it can be wrong. The big difference between now and 1995 is the presence of symptoms. If the blockage has progressed then the next best step is probably angioplasty. Diet and exercise are important also but should not stop you from taking other treatments also.
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