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Heart Disease (Expert Forum)
Chance of recurring heart attack
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Chance of recurring heart attack
by tjberm5, Jul 12, 2007 12:00AM
I am a 41yr old female diabetic who in Sept 2006 had a heart attack followed by a quadruple bypass. Within 1 week after surgery I had a bleed into my left lung from one of the graft sites which was corrected with surgery. While still in the hospital, I had trouble breathing and had to have surgery on my right lung to remove inflammatory tissue and fluid. At some point during all this surgery, I suffered a stroke in the left brain stem (according to MRI) which has left me with some mild problems (right arm weakness mainly). I have had diabetes for 27 yrs and the arteries and veins they used from my knee, arm and breast are larger vessels than the smaller ones that can give problems with neuropathy. I know they wouldn't have used arteries or veins that didn't look good to them. Am I at any greater risk for having any more heart problems than anyone else after a bypass?? I am thin, exercise and as my sugeon put it "have diabetes and bad genes"
I had no sign of this coming in Sept. I'm doing all I can to stay healthy, but was wondering about the risk for a second heart attack or even a second stroke. Are there any questions I definitely should be asking??
Thank you in advance for taking the time to look at this and reply.
I had no sign of this coming in Sept. I'm doing all I can to stay healthy, but was wondering about the risk for a second heart attack or even a second stroke. Are there any questions I definitely should be asking??
Thank you in advance for taking the time to look at this and reply.
Doctor's Answer
by CCF-M.D.-PPB, Jul 12, 2007 12:00AM
Being a diabetic and having 'bad genes' puts you at a significantly increased risk for recurrence of coronary artery blockages, heart attacks, stokes, renal disease and peripheral arterial disease. You must have taken good care of your diabetes because it took 27 years for you to develop any complications. You are also fortunate because you underwent bypass surgery and have the artery coming from your breast attached to one of your coronary vessels which has been shown to have a better prognosis in diabetics. The only thing you can do at this point is to minimize your risk factors for progression of your CAD. This means:
1. Be very aggressive with DM management. Keep your sugars, HgB A1C and your weight at goal.
2. Eat well, exercise and don't smoke (second hand smoking is just as bad).
3. Be aggressive with lipid control. Your LDL cholesterol should be less than 70, and your HDL as high as possible. Make sure your triglycerides are well controlled. Being on a statin such as lipitor or zocor or crestor provides benefits beyond lipid lowering in coronary artery disease and stroke.
4. You must be on ASA, beta blockers and statins.
5. Control your blood pressure as best as possible. The lower the better as long as your don't feel dizzy or lightheaded. Typical goal is less than 120/8. But again, the lower the better, especially if you have protein in your urine.
6. You must also be on an ace inhibitor or an angiotensin receptor blocker. They improve survival in your type of patients and post-pone renal dysfunction which portends worse prognosis in patients with CAD.
7. Unfortunately, at this stage of the game, there is nothing that we can do to change your risk related to you family history (bad genes).
1. Be very aggressive with DM management. Keep your sugars, HgB A1C and your weight at goal.
2. Eat well, exercise and don't smoke (second hand smoking is just as bad).
3. Be aggressive with lipid control. Your LDL cholesterol should be less than 70, and your HDL as high as possible. Make sure your triglycerides are well controlled. Being on a statin such as lipitor or zocor or crestor provides benefits beyond lipid lowering in coronary artery disease and stroke.
4. You must be on ASA, beta blockers and statins.
5. Control your blood pressure as best as possible. The lower the better as long as your don't feel dizzy or lightheaded. Typical goal is less than 120/8. But again, the lower the better, especially if you have protein in your urine.
6. You must also be on an ace inhibitor or an angiotensin receptor blocker. They improve survival in your type of patients and post-pone renal dysfunction which portends worse prognosis in patients with CAD.
7. Unfortunately, at this stage of the game, there is nothing that we can do to change your risk related to you family history (bad genes).
