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

[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.