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Building Collaterals after 100% RCA.
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
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
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...
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
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
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
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
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
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
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.
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