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CABG followup
I have posted before but still have nagging doubts about my heart health. I am a person who would be the last person anyone guessed had heart problems. Male at age 54 have been a very heavy exerciser for 30 years-distance runner having completed 5 marathons, competitive bicycle rided, triathalons, etc. Have virtually no family history of premature heart disease, BP normal, total cholesterol 210, HDL of 60. Last Feb, was found to have nearly total blockage of LAD and first diagonal resulting in CABG. I had no pain or noticeable decline in performance prior to surgery. Some shortness of breath in first 1/4 mile of my runs got me to the doctor. Heavy collateralization was no doubt covering for the blockage. Since the surgery, I have recovered well and am running and cycling as well as ever. I am now taking 5 mg Altace, 81 mg aspirin, 40 mg Pravachol and folic acid/B6/B12 for discovery of high homocysteine (16). LDL/HDL now 75/55.
My question: As an engineer, I yearn for some objective measurement of my cardiac status. I cannot walk up a flight of steps without wondering whether my breathing is more labored than it should be. Every evening run is a little personal stress test. For all I know, my medications and favorable lipid profile has resulted in reversal of my disease-or I may start getting symtoms tomorrow.
From my reading, I understand that an angiogram does not provide good quantitative information on diffuse stenosis. Thallium stress test has poor specificity. My insurance won't pay for a PET scan, calling it experimental. Suggestions?
My question: As an engineer, I yearn for some objective measurement of my cardiac status. I cannot walk up a flight of steps without wondering whether my breathing is more labored than it should be. Every evening run is a little personal stress test. For all I know, my medications and favorable lipid profile has resulted in reversal of my disease-or I may start getting symtoms tomorrow.
From my reading, I understand that an angiogram does not provide good quantitative information on diffuse stenosis. Thallium stress test has poor specificity. My insurance won't pay for a PET scan, calling it experimental. Suggestions?
Age 66, male of 221 lbs and smoked for 55 years. I Quit smoking. Four and one half months ago I had an MI followed by a 4way bypass. Medication is Torpol 100 mg and Zocor 40 mg daily. EKG shows a pcv regularly, but I never had one before the surgery. Sometimes I get bigemini and trigemini. It causes some discomfort and I am told that nothing can be done for it. Also, since the surgery, my stomach feels on the verge of nausea, producing bile and gas, except when I eat something - then I feel normal. I suspect the medication for this. I am lactose intollerant and I get the same reaction from aspirin.
Who says the PET was wrong? Based on my reading from the book I cited, I would tend to believe the PET over the angiogram. From what I understand, an artery with diffuse plaque could be creating angina due to greatly restricted blood flow but show on the angiogram as simply a small artery. I think I would want some resolution to this discrepancy between tests before I layed the blame on the beta blockers or whatever and got myself into trouble.
sory for the double post, the first time the board kicked back a error message, didn't mean to double up
I had angina four years ago while I was on a Beta Blocker, so they moved me to a Calcium Channel Blocker. I was able to run for the first time in years, and after a year I ran in several marathons. I had a holter right after one of the marathons, which showed four second pauses while I slept, and a HR of 190 while I ran. So he put me a beta blocker that is formulated to stop working when the heartrate dropped off.
Right away I got asthma, (never had before) and my time for 5ks went from 25 min. to 32 Min. Last October , the first hal mile of my morning runs was causing extreme SOB, my neck felt asleep, and the next two days, it felt like there was a lump in my lungs. The cardio gave me a PET, then an angiogram, because the PET showed left main blockage. The angio was clear, so the doc cleard me to resume all activity. Tomorrow I'll ask the GP to get me off the Beta Blockers. But you did give me an avenue to pursue of why the PET was so off. Thanks for your help.
Right away I got asthma, (never had before) and my time for 5ks went from 25 min. to 32 Min. Last October , the first hal mile of my morning runs was causing extreme SOB, my neck felt asleep, and the next two days, it felt like there was a lump in my lungs. The cardio gave me a PET, then an angiogram, because the PET showed left main blockage. The angio was clear, so the doc cleard me to resume all activity. Tomorrow I'll ask the GP to get me off the Beta Blockers. But you did give me an avenue to pursue of why the PET was so off. Thanks for your help.
I am 44 but also have been serious triathlete runner for 25 years. Had shortness of breath in Decemeber while running 1/4s (but who doesn't) went in one day after 6 mile run, last 3 miles with a weird chest discomfort.
I was having a heart attack, 100% blockage of LAD. I was given 2 stents though and I am back to running for about 30 minutes followed by a hard cycle of 30 minutes.
My question to you was how long before you felt confident to get back on the road? I wonder also will I need another stress test and really kick butt to find my tolerance threshold.
I was having a heart attack, 100% blockage of LAD. I was given 2 stents though and I am back to running for about 30 minutes followed by a hard cycle of 30 minutes.
My question to you was how long before you felt confident to get back on the road? I wonder also will I need another stress test and really kick butt to find my tolerance threshold.
The main thing that confuses me is if your were virtually symtomless and you were heavily collateralized, isn't that like a natural bypass? Why does anyone need an surgical bypass when it seems the body has already done the job???
I also read that ALL people have some plaque in the LAD. It has been found in aborted fetuses. Apparently, it occurs there naturally and, I guess some people have problems when there is a rupture of some sort.
Any information on the "natural" bypasses vs. surgery would be appreciated.
Thanks,
Teresa Lee
I also read that ALL people have some plaque in the LAD. It has been found in aborted fetuses. Apparently, it occurs there naturally and, I guess some people have problems when there is a rupture of some sort.
Any information on the "natural" bypasses vs. surgery would be appreciated.
Thanks,
Teresa Lee
Now I'm wondering. I started running after my GP found cronic A-Fib five years ago ( I was 35). I worked up to 40 miles a week and felt great. The cardio found on a routine ekg a slow heartrate and bumped me to a beta blocker, which immediatly killed my running. I am down to four miles a week and put up with a lot of SOB in the beginnings of runs and the day and day after, increased angina. After a recent PET my cardio told me I had a left main blockage, but the angiogram found absolutly nothing. I am blaming it on the beta blockers and am looking for a doctor that will put me back on the calcium blockers.
Now I'm wondering. I started running after my GP found cronic A-Fib five years ago ( I was 35). I worked up to 40 miles a week and felt great. The cardio found on a routine ekg a slow heartrate and bumped me to a beta blocker, which immediatly killed my running. I am down to four miles a week and put up with a lot of SOB in the beginnings of runs and the day and day after, increased angina. After a recent PET my cardio told me I had a left main blockage, but the angiogram found absolutly nothing. I am blaming it on the beta blockers and am looking for a doctor that will put me back on the calcium blockers.
Now I am confused. What should you hope to gain from a thallium stress or a PET scan, when the angiogram is the final answer?
If I failed the stress portion of the PET scan, but the angiogram showed no problem, was it because I was resting? Could your arteries shrink down excersion?
Now I am confused. What should you hope to gain from a thallium stress or a PET scan, when the angiogram is the final answer?
If I failed the stress portion of the PET scan, but the angiogram showed no problem, was it because I was resting? Could your arteries shrink down excersion?
What are PVC's?
Thanks, that was the most informative post for my problems that I have had for the past five years. I'll work it into my GP visit.
I was put on beta blockers (BB) four years ago because a holter showed my rate at 180 walking. After that didn't bring my rate down, they added dijozin. After a year , with a bad stress thallium and a good angio and PET, the doctor moved me to Calcium Channel blocker (CCB), because I though the angina started with the BB. Soon after the switch, I went from struggleing to finish three miles to running seven, then ten, Then a half marathon, then four full marathons slowly. The day after my second, I had a holter which found four second pauses at night, but a fast rate of 190 when running. So he took me off the dig, then moved me to a BB that had the drop off effect (when the heart goes slow, it ceases to block the adrenaline). The following week, I found myself with asthma while running. We cut the dose in half and moved it to night, My running times went from 9minute miles to 12 minute miles, and as the year passed. angina kicked in when I tries to run. When I asked to go off the BB, they did a PET, which showed left main blockage. The angio showed nothing. I ran two this morning and tomorrow I am going to beg to go back on the CCB.
I have tiny veins anyway, but how can they tell if the veins on my heart have plaque, if it is all even . It is my understanding that CCB enlarges the blood vessels, maybe that is why I could run.
My cardiologist already said if the angiogram was clear, I have no restrictions. Thanks again
I was put on beta blockers (BB) four years ago because a holter showed my rate at 180 walking. After that didn't bring my rate down, they added dijozin. After a year , with a bad stress thallium and a good angio and PET, the doctor moved me to Calcium Channel blocker (CCB), because I though the angina started with the BB. Soon after the switch, I went from struggleing to finish three miles to running seven, then ten, Then a half marathon, then four full marathons slowly. The day after my second, I had a holter which found four second pauses at night, but a fast rate of 190 when running. So he took me off the dig, then moved me to a BB that had the drop off effect (when the heart goes slow, it ceases to block the adrenaline). The following week, I found myself with asthma while running. We cut the dose in half and moved it to night, My running times went from 9minute miles to 12 minute miles, and as the year passed. angina kicked in when I tries to run. When I asked to go off the BB, they did a PET, which showed left main blockage. The angio showed nothing. I ran two this morning and tomorrow I am going to beg to go back on the CCB.
I have tiny veins anyway, but how can they tell if the veins on my heart have plaque, if it is all even . It is my understanding that CCB enlarges the blood vessels, maybe that is why I could run.
My cardiologist already said if the angiogram was clear, I have no restrictions. Thanks again
You have me confused. I would think that prescribing beta blockers in the context of a slow heart rate would be the last thing he would do. They tend to slow the heart rate. He may have considered the heartrate no problem and prescribed the beta blockers for the A-fib.
There is some disagreement over the value of angiograms in determining plaque, particularly diffuse plaque. That test can only see the active flow channel within the artery and does not image the wall itself. Thus, you may be down to 30% effective diameter for the whole length of the LAD and it would look small but normal if there were no localized lesions. A book by K.Lance Gould (Heal your Heart) should be very interesting to you.
I would personally be very careful about running if a PET scan indicated I had serious ischemia. Studies cited by Gould showed the PET has an average specificity for ischemia of 95 to 100% (specificity is the absence of false positives).
There is some disagreement over the value of angiograms in determining plaque, particularly diffuse plaque. That test can only see the active flow channel within the artery and does not image the wall itself. Thus, you may be down to 30% effective diameter for the whole length of the LAD and it would look small but normal if there were no localized lesions. A book by K.Lance Gould (Heal your Heart) should be very interesting to you.
I would personally be very careful about running if a PET scan indicated I had serious ischemia. Studies cited by Gould showed the PET has an average specificity for ischemia of 95 to 100% (specificity is the absence of false positives).
I had a 100% blockage of my LDA and an MI with no ischemia present per a thalium stress 1 month ago. I have been running treadmill 25 minutes (5 on 1 off) for about 3 weeks now followed by a pretty hard bike ride of 30 minutes or so all the time keeping around 110-120 BPM per heart moniter. Running 11 minute miles down from 6 a few months before MI.
Anyway, I get pretty beat after workout and it takes several hours to feel good. Sort of like doing a hard 10 miler your legs are kind of weak butw with me now my chest and legs feel all achy, not painful, just achy. Is that how you felt when you first started? I don't want to end up dead in my front lawn, my wife would be pissed.
Anyway, I get pretty beat after workout and it takes several hours to feel good. Sort of like doing a hard 10 miler your legs are kind of weak butw with me now my chest and legs feel all achy, not painful, just achy. Is that how you felt when you first started? I don't want to end up dead in my front lawn, my wife would be pissed.
I had a 100% blockage of my LDA and an MI with no ischemia present per a thalium stress 1 month ago. I have been running treadmill 25 minutes (5 on 1 off) for about 3 weeks now followed by a pretty hard bike ride of 30 minutes or so all the time keeping around 110-120 BPM per heart moniter. Running 11 minute miles down from 6 a few months before MI.
Anyway, I get pretty beat after workout and it takes several hours to feel good. Sort of like doing a hard 10 miler your legs are kind of weak butw with me now my chest and legs feel all achy, not painful, just achy. Is that how you felt when you first started? I don't want to end up dead in my front lawn, my wife would be pissed.
Anyway, I get pretty beat after workout and it takes several hours to feel good. Sort of like doing a hard 10 miler your legs are kind of weak butw with me now my chest and legs feel all achy, not painful, just achy. Is that how you felt when you first started? I don't want to end up dead in my front lawn, my wife would be pissed.
To your question about PVCs, they are premature beats from the lower part of the heart. A very large percentage of the adult population have them and they are generally considered to be benign. However, in rare cases, they may be the result of poor blood flow to the heart (ischemia).
I started running about 8 weeks following surgery. It was tough at first due in part to low hemoglobin from blood loss during surgery-about 3 pints low. I ran a 5K race 4 months after surgery rather conservatively at a time about 3 minutes slower than I would have expected prior to surgery. I did a 5 mile on Thanksgiving 1 minute slower than the same race prior to surgery taking 6th place out of 150 runners in my age class. In your case, you should be able to hit the road almost immediately, since there was no surgery to recover from. That said, there seems to be a wide divergence in opinion as to what is safe for runners. I have had two cardios urge caution saying that plaque could break off causing a heart attack. My own cardio told me to do anything I wanted to at 4 months-no restriction. Without trying to scare anyone, a good friend's father was found dead in the front yard after returning from a run. He had angioplasty a few month prior.
I started running about 8 weeks following surgery. It was tough at first due in part to low hemoglobin from blood loss during surgery-about 3 pints low. I ran a 5K race 4 months after surgery rather conservatively at a time about 3 minutes slower than I would have expected prior to surgery. I did a 5 mile on Thanksgiving 1 minute slower than the same race prior to surgery taking 6th place out of 150 runners in my age class. In your case, you should be able to hit the road almost immediately, since there was no surgery to recover from. That said, there seems to be a wide divergence in opinion as to what is safe for runners. I have had two cardios urge caution saying that plaque could break off causing a heart attack. My own cardio told me to do anything I wanted to at 4 months-no restriction. Without trying to scare anyone, a good friend's father was found dead in the front yard after returning from a run. He had angioplasty a few month prior.
MD BKJ
I appreciate your comment pertaining to the stress test being a performance measurement. However, the speed I am able to maintain on my bike is probably a much more senstive measurement of performance, particularly if I watch my pulse for a given speed. Also, hill climbing ability when riding with the same companions gives a lot of information. The Bruce protocol advances the work load in too large of increments to be useful. The real issue here is that I never saw any deterioration in performance in either running or riding right up to surgery. I achieved 150% of predicted VO2 max (52 ml/kg)on the treadmill two weeks before surgery. (Fatigue limited) This raises the obvious question as to whether CABG was actually necessary although I realize an LAD blockage does meet the criteria. After the cath, the cardio told me I had a serious blockage and he was not letting me leave the hospital until it was fixed. I felt at the time like I was a walking time bomb and scheduled surgery for the next day. From subsequent reading of this forum, I think I would have a few more questions now.
The transient shortness of breath I was experiencing at the beginning of my runs now is gone so I guess there was some value to the CABG. The other positive aspect is that it was certainly a wake up call that I do have heart disease. I am sure that discovering the homocysteine issue and getting my cholesterol down will benefit me greatly.
Hankstar,
You are right on about the PVCs. Only correction would be that I have never felt them. I am only aware of them if I am taking my pulse by hand or when my pulse watch "sticks" on a reading and fails to update. The PVC's were the primary concern of my GP who gave me the last treadmill but that concern appears to have been unfounded. I had many more PVCs after CABG even when not exercising. Now, more fully recovered, they have disappeared at rest but are still present during exercise. I have noticed that they are quite sensitive to how tired I am.
An additonal comment to gaspipe is that I thought I had heredity working in my favor. My father is the only one of his siblings not living (died of cancer at 79) and mother and her 3 siblings are alive and well. The youngest of the 9 on both sides is 72 and the oldest three are 89, 90, and 91. Go figure.
I appreciate your comment pertaining to the stress test being a performance measurement. However, the speed I am able to maintain on my bike is probably a much more senstive measurement of performance, particularly if I watch my pulse for a given speed. Also, hill climbing ability when riding with the same companions gives a lot of information. The Bruce protocol advances the work load in too large of increments to be useful. The real issue here is that I never saw any deterioration in performance in either running or riding right up to surgery. I achieved 150% of predicted VO2 max (52 ml/kg)on the treadmill two weeks before surgery. (Fatigue limited) This raises the obvious question as to whether CABG was actually necessary although I realize an LAD blockage does meet the criteria. After the cath, the cardio told me I had a serious blockage and he was not letting me leave the hospital until it was fixed. I felt at the time like I was a walking time bomb and scheduled surgery for the next day. From subsequent reading of this forum, I think I would have a few more questions now.
The transient shortness of breath I was experiencing at the beginning of my runs now is gone so I guess there was some value to the CABG. The other positive aspect is that it was certainly a wake up call that I do have heart disease. I am sure that discovering the homocysteine issue and getting my cholesterol down will benefit me greatly.
Hankstar,
You are right on about the PVCs. Only correction would be that I have never felt them. I am only aware of them if I am taking my pulse by hand or when my pulse watch "sticks" on a reading and fails to update. The PVC's were the primary concern of my GP who gave me the last treadmill but that concern appears to have been unfounded. I had many more PVCs after CABG even when not exercising. Now, more fully recovered, they have disappeared at rest but are still present during exercise. I have noticed that they are quite sensitive to how tired I am.
An additonal comment to gaspipe is that I thought I had heredity working in my favor. My father is the only one of his siblings not living (died of cancer at 79) and mother and her 3 siblings are alive and well. The youngest of the 9 on both sides is 72 and the oldest three are 89, 90, and 91. Go figure.
Gaspipe,
You are rigth-its not fair that I have heart disease. Neither is it fair that young mothers die of breast cancer, kids get killed by drunk drivers, or 3000 people die in the Trade Center. In my case, however, I think with the state of medical science, my problem is probably fixable if the root cause(s) could be identified. My current belief is that the problem is due to a stack-up of a number of borderline factors such as cholesterol, homocysteine, and other "second tier" factors such as second hand smoke, mercury from amalgham fillings, bacteria from poor teeth, etc. Again, the key to knowing whether one is making progress against these is measurement. The PET scan would appear to be the perfect tool to document the progression or regression of disease over time. I'm not sure I am ready to sign up for $2500 a pop.
You are rigth-its not fair that I have heart disease. Neither is it fair that young mothers die of breast cancer, kids get killed by drunk drivers, or 3000 people die in the Trade Center. In my case, however, I think with the state of medical science, my problem is probably fixable if the root cause(s) could be identified. My current belief is that the problem is due to a stack-up of a number of borderline factors such as cholesterol, homocysteine, and other "second tier" factors such as second hand smoke, mercury from amalgham fillings, bacteria from poor teeth, etc. Again, the key to knowing whether one is making progress against these is measurement. The PET scan would appear to be the perfect tool to document the progression or regression of disease over time. I'm not sure I am ready to sign up for $2500 a pop.
After readind your post it became apparent how unfair life can be.I mean you see overweight out of shape smokers who drink to much still going strong at 65.But unfortunately genetics and bad anatomy can do any of us a bad turn as this forum shows.Another comment it seems regular and nuclear stress tests get bad mouthed here a lot yeah there are not perfect but have certanly saved many many lives.If you can get a better test to help you answer your health questions and insurance won't pay for it then pay for it out of your pocket. If you can't afford it take out a loan and get it done!! People think nothing of spending thousands on a week long vacation so think of it as a mental health vacation.
MEDICAL PROFESSIONAL
tom,
There really isn't a 100% solution for you, but a good option for someone in your shape is the exercise thallium.
If you are able to exercise, a yearly stress test(on the treadmill, not with drugs for the stress) will give you a concrete measure of the amount of work you can do for comparison over time.
Also, now that you have bypass grafts, the nuclear protion of your test should help detect if there is ischemia in the areas bypassed.
Good luck
There really isn't a 100% solution for you, but a good option for someone in your shape is the exercise thallium.
If you are able to exercise, a yearly stress test(on the treadmill, not with drugs for the stress) will give you a concrete measure of the amount of work you can do for comparison over time.
Also, now that you have bypass grafts, the nuclear protion of your test should help detect if there is ischemia in the areas bypassed.
Good luck
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