Building Collaterals after 100% RCA.

[Mitch031965]

Hi

I'm 44 and had a mild MI 5 weeks ago, they discovered I had a CTO of the RCA, which they tried to stent but couldn't get the wire through. Subsequent perfusion test and Ct- Angiogram reviled it was a long standing blockage that had been building for 10-15 years. My perfusion test indicated that the area below the blockage is getting 90% flow at 85% of my max on the treadmill, this combined with the Ct-Angiogram has resulted in no further action due to collateral growth. (Luckily my LCA was completely clear)

As its only 5 weeks after the MI and failed Angio, is it wise to start pushing my heart to try and expand the collateral growth. My history is I’ve never smoked always eaten healthily... and done competition cycling/running up until the day before my MI. (In fact I thought it was indigestion and did a 12km run during it which made the indigestion/angina go away).

I've been doing 30 mins swimming in my pool every day and a 4km walk on the beach, but have noticed a mild feeling of heat across my upper back, I wouldn’t call it pain, so I was wondering what should I be feeling is this normal, or am I doing too much too soon.

Thanks in advance for any info.

Mitch

[Mitch031965]

Hi

Things are all good now, over 2.5 years since my  MI, still keeping the weight down, although a bit has crept on over the last six months... but its summer soon so it will all go once I start swimming and cycling more...

my cholesterol has stabilized and still on the 40mg of Crestor, BP is averaging around 120/70  with a resting pulse of 52-60.

Still eat healthy foods and learnt to eat less and not to pig out, still enjoy food but in moderation and none of the really crap stuff..

Still sticking to my light beers when available a few glasses of red wine etc...  

Excersice is mainly working hard on renovations and decorating my house, but surfing, cycling, 5-aside soccer and basketball are all in there on a regular bases..  

All in all nothing to complain about... but then again one never knows !!

[tim59]

I read all of your post through last year...how are things today?

[Mitch031965]

Hi All

Well its now 14 months since my blockage and attempted agioplasty, all in all things seem back to normal, been doing some hard cycling and swmining and no pains or angina feelings... so im hoping my heart and collaterals have remodelled and with the drugs and healthy lifestyle ill be here for a lot longer than I feared last year.

Basically, ive cut out all fat, only eat healty food, lots of it I add... only drink light beers, and no saturated fats, like crisps, pies etc etc... just healthy food all round.. not too much excercies... have lots 18kgs and now steady, still have the fear of food is going to kill me... thats why I eat lots and lots of good stuff... keep myslef ocupied with good food and try not to snack and eat junk... I eat sushi and granary lowcal everything...

my ED has now gone, the low dose of cialis seemed to do the trick, although I believe I had a stone of some kind that came out 7 months ago... had a lot of pain and blood during sex, im suspicious of what my kidneys had to clear out affected my bladder, prostate and lower areas, but all seesm ok now, proabably never get tot he bottom of it... but im happy its better... so all in feelign good and lookign forward to focusing on enjoying myself.

Regards

Mitch

[oldie]

Top marks for your forthright sharing of ED and 'skudding along the bottom' problems.  My small group are with you on  both counts. Please keep your updaters coming. Meanwhile, what measure  was the low dose of Cialis? I had a RCA stent four months ago.I exercise hard
but still have symptoms none of which seems in any way connected with heart trouble. I suspect the Lipitor , 20mg, and Coreg, 6.25, Vastarel, Plavix are  causing them and they are similar to yours. My BP and cholesterol are within normal limits. But I'm still at half speed

[Mitch031965]

Hi , Its now 7 months since my heart attack and things have calmed down physically almost back to normal. Had my 6 month review wiht my cardio and she stop the plavix as I didn't have a stent, so I'm only on the ARB, ASperin and Crestor now...and of course a raft of other minerals !...

Still doing excercise 2/3 times a week, nothing to intense and still eating healty maintinng 83kgs even after a few weeknds of celebration and indulgence !... gettting used to the food and what I need to do to reduce my risks...

Only thing is the mental issues, not sure if its the drugs or depression or something, but can;t seem to get off the bottom.... I'm jsut skudding along the bottom, draggin my feet...almost like Iv'e lost the will to try to do anything... I'm hoping time will make it better and maybe I'll get some enthusiasm back, I'm beginign to wonder if I've got soem kind of adrenalin fatigue or something....

my bp is still stable   115/65   bpm 56  and colestral last checked was 2.9... I'm still suspicious of my low cholestral....  I try to eat more food to get it up, but then my mind play tricks on me and I can almost visulise the layers going down in my heart....catch 22 really !

So all in all... good + bad...

I'll try and do an update again ina few months

Cheers

Mitch

[Mitch031965]

Ok, further update...

Had a meeting with my cardiologist and the changed my Lipitor to Crestor 40mg which is helping with the mental issues.

I have been to see a sexual specialist for the ED and he seems it think my Sympathetic nervous system was adversly affectd by the metoprolol, seeing the feelings and nervous issues Iv'e been having.. He started me on a very low dose Cialis 3 weeks ago and that has made a world of a difference... the nerves have all slowly been coming back to life and even the skin texture is now nearly back to normal.  The ED has 80% gone now and nearly back to operational status. I'm hoping to reduce the cialis slowly after a few months, but I'll leave it upto the docs to decide.  

My weight has now stabalized at 82kgs (down from 97kg)  my BP is now stable at 110/70 from 180/110... so all in all feeling pretty good and still doing excercise, although I have reduces the intensity after my cardiologist recommended I don't exceed 155bpm.


I'll try and keep regular updates every month or so...  its now 5 months since my MI and although its still prevelant in my mind, I'm begining to look forward more and not dwell on the "what if" scenarios that lurk in your head !!

cheers

Mitch

[Mitch031965]

ok, furhter update... after 2 weeks off the lipitor the ED was still there... the colestral test had prooved it had gone up so they have now had me back on lipitor 40mg...hopefully being off it for 2 weeks prooves its not the lipitor... off to a specialist tomorrow to check the other meds ... at the moment its the ramapril that seems the most likely... the chemists and what I've read say it can numb the sympatetic nervous system which explains the disconnect feeling and total lack of erections, although the morning/sleep erections are now back every now and then... so I'm hoping/wishing they get it sorted... its been over 3 months now and its starting to affect me badly...

[Mitch031965]

Ok update after two weeks of the Lipitor....

Unfortuanatly the situation has is not much better in the ED department, the mental forgetful stuff has virtually gone, no mood swings and generally happier.... the ED seems slightly better, still only 20% of what it used to be... weak or no erections, inability to ejaculate...lost sensitivty in the glands.... basically totally useless... going back to see the doc this week... its like something has killed all the feeling in that area...mentally I know its ok, but physically its like a numbness... I did read that neropathy is a side effect of statins, and ED is well know... I'm just mega worried now that its broken the connection.  I still get night time and morning erections when I'm asleep which gives me confidence its a nerological issue, just can't get an erection  when I want....or need as the case may be !!  

My BP 24 hours after the ramipril is now around  118/68  HR 51...  still on my low fat, healthy diet... did 2x50km bike rides over the week, lots of walking, weights etc... so feeling good.... jsut need to fix the ED now...

Cheers

Mitch

[kenkeith]

QUOTE: "Yeah the collaterals can be clearly seen on the Angiogram, and in the CT-Angiogram, Iv'e had both done. They are well foremed and one very large feed from the Left side, with multiple feeds of various sizes feeding the distal side of the blockage."

It seems collateral vessels (arteriogenesis ) develops with larger vessels due to intravascular gradient pressure, and can be visualized conventionally.

However, angiogenises is the formation of smaller vessels that develop and provide a link between larger vessels.  It is a network of vessels <30 um (limit of resolution for conventional imaging) that requires SR microangioplasty to visualize.  It appears the stimulation of endothelium cells (lining of vessels) and the production of VEGF grows the network of smaller vessels.


Since improvement in collateral-dependent flow typically results from the proliferation of vessels less than 180 μm in diameter [8–10], it is possible that conventional systems of angiography, which cannot visualize arteries <200 μm [11, 12], fail to display the full extent of collateral formation, leading to an underestimation of the angiogenic potential of VEGF. vessels. This improvement in blood flow was documented by intravascular Doppler analysis and magnetic resonance imaging. In some cases,

Arteriogenesis refers to formation of mature collaterals. Its three-layer structure is indistinguishable from a normal coronary artery of the same size. Migration of monocytes, smooth muscle cells and endothelial cells as a result of the increased shear stress induces this transformation. Angiogenesis refers to sprouting of new vessels from preexisting blood vessels and results in the formation of smaller, capillary-like structures. Migration and proliferation of endothelial cells occurs with formation of capillary sprouts.
Recent investigations in animal models indicate the feasibility of using angiogenic growth factors to augment the development of collateral arteries. We [2, 3]and others [4]have shown that the endothelial cell (EC) specific mitogen, vascular endothelial growth factor (VEGF) [5, 6], is a potent agent for augmenting the development of collateral vessels in the lower extremity and in the coronary circulation. This new approach to the treatment of vascular insufficiency has been termed therapeutic angiogenesis

[Mitch031965]

Hi

Yeah the collaterals can be clearly seen on the Angiogram, and in the CT-Angiogram, Iv'e had both done. They are well foremed and one very large feed from the Left side, with multiple feeds of various sizes feeding the distal side of the blockage. The doctor only commented alst week how impressive they were, and Im assuming thy are all ehalty as I'm doing virtually as much excercise as before with no issues... did a 45km bike ride yesterday holding 160bpm...crusining really....(BP now 120/68 at rest...24 hours after tablets, so hopefully they will lower that med too)   Pulse is around 50-52 at rest...

Update on the Lipator... I've been off it now for juat over 4 days... and already I'm feeling better..... the vaugness in my brain and gonads is disspearing slowly... hopefully I'll recover fully.... but i was on 80mg for nearly 3 months... I'm just hoping the stuff hasn;t perminanlty damaged me.... My cardiologist wan;t happy, but with my diet and excerise I took the decesion that 1 x 100% blockage can;t get any worse..!... and no build up anywhere else the risk is lower of plaque peeling off etc....

Well give another update in a week...

Cheers

Mitch

[ed34]

I dont think all collaterals are the same thickness, not from what my cardiologist was saying. I had an angiogram last year to see if any were large enough to be forced open using a stent to give a bigger flow, something he has done several times before. Alas, none were good enough, they were so small that only a nuclear scan revealed their obvious existance.

[oldie]

please clear a point. Your doctor   pointed out your collaterals during the angiogram. Was this a catheter angiogramm or a CT-high tech procedur?. I have long wanted to know how collaterals are SEEN.

[Julie62785]

Hi All!
Sitting here reading these posts regarding Mitch's reaction to lipitor and his problems with memory.  I had exactly the same thing happen to me following placement of two stents in my distal RCA. I had 99% blockage at that time.  The blockage caused heart stunning, which means it took a bit for the heart to function normally again, but my cardiologist put me on mega dose - 80 mg of lipitor even though my cholesterol levels were where they were supposed to be at 10 mg.  (In hospital test showed my LDL at 57 and after MI they want to see LDL level below 70, I didn't say that I previously had two heart attacks about a year prior to that from artery spasms...not blockage).  He told me he prescribed higher dosage because the higher level of lipitor also reduced the inflammation which should prevent a recurrence of blockage...however, I had body pains and HUGE memory issues shortly after starting the high dosage.  Hated it...Also, my LDL level was down to 17 which concerned me because the brain needs some cholesterol to function properly.  When I questioned the low LDL, I was told there is no such thing as LDL too low???  WTH???  Really???  How do they know that?  How many people walk around with LDL of 17?  NONE that I know of...I will be interested to see how you do with reduced dosage.  I am now down to 40 mg because I complained so loudly and so long!  Good luck!  

[Mitch031965]

Ok, docs agreed today to do a trial 3 week stopping of my Lipator....  My lipids are mega low.... I'm eating a mega healthy diet, doing lots of excercise and my BP is way down...110/68 today aftter doing 60 mins in the gym....resting pulse 50....Doc agrees that maybe the ultra low Cholesteral maybe affecting pathways and nerves, memory issues... so lets see what happens.... if there is no change... I'm gonna go through the other ones... although the plavix will be stopped in jsut over two months anyway as I didn;t have a stent.

[kenkeith]

Yes, if I understand what your saying, if a blocked vessel is opened there will be less gradient pressure and blood flow will again flow through the previous, now opened blocked vessel and less blood through the collaterals.  That may be a good reason not to open an occluded vessel that has good collateral blood flow.  Blood will flow through the least resistant channels and that would be the wider diameter of the opened vessel. Collaterals usually have a smaller diameter and more resistance.

You are correct as the occlusion grows the gradient pressure increases, and new channels with less resistant collaterals begin to develop.

[ed34]

"An acute blockage can develop collateral vessel perfusion."

Thanks I didn't know that. I assumed they always developed to counteract a lack of blood supply once the blockage was over a given percentage. I wonder if collaterals close back down if a stent is used to open a fully blocked vessel. I assume the greater pressure flowing through the opened native vessel would be too much for tiny collaterals to push against?

[kenkeith]

QUOTE:" I didn't realise that collaterals developed that quickly. Usually they start to form as the blockage develops and are ready in situ for when the artery completely blocks. In your case, to suffer MI, I have to assume the collaterals were not ready, or the MI would not have occurred. Now they are telling you that as the MI was occuring, the collaterals opened?"

An acute blockage can develop collateral vessel perfusion.

[ed34]

The problem often overlooked is that Cholesterol is used in all areas of the body. It is seen as a 'killer' but without it we would die, which is why the body makes it. The UK actually raised the recommended cholesterol level of heart disease patients last year in belief that if the level is too low it will cause too much harm.
After three weeks the beta blocker will definitely be out of your system.
Ramipril is very unlikely to give you any problems, this is one reason Doctors love the drug. My Cardiologist said it actually does something to help the kidneys too, but she got a bit over technical explaining that one. Your personal problems, in my opinion anyway, are psychological rather than physical. I have heard after having heart issues, this is not an uncommon thing.

[Mitch031965]

I'm tempted to stop the Lipitor myslef and see if it makes any difference... the ED is reduced the further from taking the Lipitor, what little there is last thing at night before I take the tablet....
... I'm sure my mega low cholesteral and strict diet is wrecking the balance....  it seemed to rapidly get worse with doing excercise....hmmmm  

[Mitch031965]

Ok, another week of cronic ED, the doc has halved my Lipator to 40mg...I'm begining to think something has stripped me of all my testosterone.... low libido...pathetic erections and loss of feeling in the penis....what the F has this stuff done to me.....3 months ago when I came out of hospital everything was fine... now 3 months later its mentally ruining my life....its either the plavix, ramipril or Lipator.... they stopped the metoprolol 3 weeks ago, so I'm assuming thats all gone now.... my BP is down the 125/75 in the morning before the BP tablets.... resting HR at 53....so its back to the docs this week...
My excerice levels have still been good did 2 bike rides over the weekend....  1 x 20km ride and 1 x 40km ride....both holding an average of 160bpm... no issues...feeling good... apart from the ED issue...  any ideas, thoughts anyone...

[ed34]

It is a known fact that the brain uses a lot of your cholesterol to protect the connections between neuron cells. It basically coats them in fat to make a permanent connection. It has been reported on several occassions by different Doctors that some of their patients have suffered memory loss. Is this rare? who knows, it seems everytime a Doctor tries to raise a problem it gets swept into the background and under the carpet, by who I have no idea. I do know that Lipitor has the least number of side effects reported and your cholesterol would have to be off the scale for over 40mg to be prescribed. I have familial hypercholesterolemia and 40mg does more than enough. If you have no severe muscle pains, then I doubt if the Lipitor is doing anything else to you.

[Mitch031965]

Ok, after over a week off the metoprolol the ED is still not any better... so its back to the doctor this week... Lipitor is going to be cut in half (down to 40mg)... my lipid levels are way low and its freaking me out now, I think something is affecting my memory.... keep forgeting stuff and cant concentrate... been on statins 3 months now and the fear factor is kicking in... what else is it doing to me !.....

[Mitch031965]

ok, went to my first cardio rehab session with the trainer today and was really please with my recovery, we did some bike work first holding 160bpm for 10 mins, then some weights, arms, legs etc, then back on the bike to finish, where we did a bit of a stress test to see if there was a threshold I need to be aware of. After a coupe minutes holding 160 we increased the resistance and cadance and increased my heart rate upto 180, which I held for 3 mins... no pain or symptoms, then backed off and held 175 for another 3 mins....(the highest reading was 182)

As you can imagine I'm pretty pleased with the results and all feels like normal, which is great.... !....

[kenkeith]

Thanks for the update.  You are doing well, but it may take some time to adjust to the medication, if not, consult with your doctor.