Building Collaterals

[Kiwi01]

Dear CCF Doctor:

I am trying to reduce angina symptoms when I walk by building collaterals or what ever method works and would like your recommendation as to the best form and approach to exercise and/or non-exercise to relieve angina symptoms.  I have had bypass surgery in the last 6 months and the doctors are not sure what is causing the pain.  I suspect it is difficult to give advice without knowing the cause of the pain but I want to try the best approach before undergoing invasive testing.  I am on beta blockers and a nitro patch but this has only helped a little.  Thank you very much for your help.

[Cleveland Clinic, MD]

Dear Ralph,
Not all chest pain is due to ischemia (lack of blood flow to the heart) but in someone with your history it is the first "suspect".  I would recommend proceeding with testing to make sure the bypass grafts are not occluded and then go from there.  If they are occluded perhaps a PTCA or stent can be used to help relieve your symptoms.  If they are open then other sources for the cause of the pain must be identified.  Depending on what is causing the pain the treatment will be very different.

[Bill Serrahn]

Daily walking as much as you are able, without getting overly tired, is good.  Walking uphill, as slowly as you need to go, is better.  It's preferable to do it in a pleasant place outdoors rather than a treadmill.

Many studies have shown that collaterals are built, in some hearts, as a response to ischemia.  In my case I have a totally occluded RCA which was shown to already have a moderate collateral system servicing the area downstream from the blockage.

I have eliminated angina and increased my physical capability over the last year by walking and hiking.  I just got back from spending a week camping and hiking above 9,000'.  After walking an average of 7 miles each day, I would be hurting like I used to at sea level after my heart attack.  By the end of the week, I was feeling pretty normal and now feel like superman back at sea level.  I am hoping that these high altitude sessions will increase my circulation like it does for people who live high in the Andes.  Again, I believe that the body will compensate for 1/5 the availability of oxygen, by producing VEGF and hence enhancing your circulatory system.  

This is not a matter of you conquering your heart disease through exercise.  I believe that my coronary artery blockages where caused by heredity and my approach to life, for which my poor heart paid the price of my arrogance, self-centeredness, stupidity, anger, and negativity.

There is a mental, spiritual, and physical aspect to recovering from coronary artery disease.  Also, it took you 30 or 40 years to get in this situation and the best that you can hope for in a year is to halt the progression or push it back a little.

As a first step, stop thinking of your heart as a pump or a machine.  Give your heart the status of a friend.  This is your best friend - a friend that's always there for you.  Give your friend a name.  Regard your friend in everything you do, everything you eat, everytime that you get angry, every time that you allow yourself to get stressed, etc.

Other Things:

1.  Get an exercise pulse meter - find out what pulse rate that you can exercise to, before encountering angina.

2.  Drink a couple of bottles of water every day.

3.  Eat fruit and salad - don't buy any meat at the grocery store - save 75% of the meat in any restaurant food for your dog.

4.  Drive slow, be courteous at all times.

5.  If you have enough money, don't work all year, learn how to enjoy life without working.  Learn how to support yourself without working all year.

6.  Have as much fun as you can - you might not live forever.

And remember that it's the process that counts more than the goal.  If you are loosing weight, your cholestorol is decreasing, your angina is releived a little, your heart rate is a little slower, your exercise tolerance is a little better - that's progress.  As long as you are going in the right direction you will be ok.

Also, unfortunately we all have bad weeks.  Some of this is due to our condition and some of it due to medication.  It's nice when the bad weeks become fewer and farther between.

Best Regards,

Bill

[nmum]

Message to Bill..
Thanks for your thoughts bill. I did not post the original message, but I appreciate your comments.

[roger]

Good to hear fom Bill  again.  Glad that things are going well.  Seems to me that not enough attention is paid by researchers to building collaterals and preserving grafts.  Since there are approximately  400,000 CABG operations PER YEAR, each involving multiple grafts, there are millions of people affected.  The life of  vein grafts  appears to be about 7 years (depending on where you get the statistics), longer for artery grafts.  Second CABG operations are common and likely to increase.   I, like Bill, am willing to do anything I can to preserve the grafts and build new collaterals.

Does anyone know of research findings, ongoing research, organizations or information related to the creation of collaterals  and the preserving of grafts?

[Bill Serrahn]

Hi Roger,

I have just passed the 1 year anniversary of my heart attack and subsequent failed angioplasty.

Of course when this disease finally stops us we have little knowledge of the disease and it seems logical that if the sewer pipe in front of our house is plugged it has to be unplugged or a new sewer pipe has to be installed around the plug.

I was given the option of a minimal invasive bypass and had insurance to pay for it.  I guess that it's not such a big deal, is done everyday, and may have been the best answer, but it still scared the hell out of me.  Also when my cardiologist told me that bypass is good for an average of 7 years (although many are good for 15 or more), being only 50, I really didn't want to go through that and look at the prospect of having it done again in 7 years.

Of course having an a total occlusion of the RCA is not as bad as having one in the LDA, so it may be easier for me to live with this blockage than other patients.  Also, I would say that one year is not enough to determine if I made the right choice or not.  I hope to be thriving 5 years from now.  If I reach a dead end with exercise, diet, and the other changes that I have made, I may still have to take a surgical option or hopefully, in that case, I can have it done with the Spectranetics total occlusion angioplasty system used by Dr. Hilton in Victoria, B.C.

I can say that I am glad that this physical condition has forced me to change just about everything involving my approach to life.  If I would have felt great after a quick surgical fix, I could have gone on with business as usual.  Too bad that it took a heart attack, but I have been happier and more active in the last year than I have for many years.

I also think that it's important that we just don't go into the doctor and expect them to fix us and give us some drug that is going to cure us.  All of the drugs have side effects and cause other problems.  The disease progresses, whether we do surgical revascularizations or not.  We must take responsibility for our health and feel that we are doing something to survive and become healthy whatever that might be.  Having a surgical intervention and then going back to our high stress job, high fat diet, and sitting in front of the TV every night is not the answer.

And you can only do so much by getting out in the fresh air hiking and skiing, watching the fat, taking Lipitor, and changing your mental attitude.  A year later I still know where my limits are and they are still very real.  But I do believe that I have improved a little over the year.  It took me 50 years to get to a point where I only had 1.3 functioning coronary arteries and just stopping the process in the first year would be a major accomplishment.

I don't know if science will ever know why some people build collaterals and others don't.  If you see me up in the mountains talking to my heart and giving her thanks for getting us to the top, you will probably think that I am completely nuts and that there is no way that will help build collaterals, but I believe that it can.  I don't think that science can quantify that.  On the other hand, how many people will you find up there with 1.3 functioning coronary arteries?

Take care,

Bill

[roger]

Thanks for the reply.  Sounds like we are both taking the same approach:  surgical intervention, care of a cardiologist, exercise, diet, gereral taking care of self, lipitor.  I also take  an ace inhibitor, fish/flax oil, vitamin B, vitamin E, multivitamin, coated aspirin.   Have you investigated the Dean Ornish diet and plan for reversing heart disease?  I follow most of his recommendations and the three cardiologists I have talked to agree with the diet, but do not push it with patients because the diet is rather hard to follow -although I don't agree, especially with the high stakes involved ( life )!  Some tests have shown the plan to be effective  with stopping the progression, and some slight reversal. The tests I saw were for a few years and like you said  ---It took 50 years to develop the disease.  I think medicare is doing some studies.  I don't think it is a substitute for surgery in many cases So far-so good,  with me.   I hope you and all others continue to improve.  Good Luck.