Thoughts? (father's coroner's report)

[Rosemary349]

Hi there those that remember me

As you know it's nearly the anniversary of my father's passing last sept 2009.  I have only just received the coroner's report.

You may remember i wondered how he could die of a ruptured myocardial infarction when he showed no signs of chest pain or angina leading up to the event.

Well from the info from you guys and now reading the report it would seem that he did have 'eccentric' cholesterol full athermona in the circumflex artery (the offending artery) which had narrowed the artery down to a pin point and a thrombus had formed there.  The LAD was 'moderately severely' diseased with calcified atheroma also.  The artery serving the right ventricle was 'patent' all the way through - i get the impression this means that it was clear.

So he didn't just have a heart attack out of the blue - assuming this took a number of years to develop (Not overnight?) - thoughts on this?  I would say that he did seem to change over the last two years but everyone thought it was the stress, there were a lot of changes taking place in his business and we all just thought he was getting a bit old for all that...not that he was old at 64, in fact he seemed very young and full of energy still - still surviving on four hours a night.....but he was looking tired......and his behaviour seemed more, well like he was sticking to the daily routine of work and not really having much energy to sit down and plan ways to make it easier for himself.

There was 'moderately severely' atheroma in other areas also, including moderate in the aortic arch.

It made me really sad reading the report.  I was thinking that there wouldn't be any real 'disease' because he seemed so fit .....but the thought that the heart attack was a fluke bothered me too.  In some ways to think that this all just went unnoticed means that 'at least' (sounds crazy i know) there was something wrong.  If there had been very little occlusion of the arteries then i would be left thinking omg, people just die.

I'm left wondering what caused it all.  Both his parents lived until they were 80/82.  His father smoked and lived to 82.  Unsure of the cause of death, but he was very ill with emphysema.  His mother had an MI.

I often wished my dad could 'calm down.'  I felt there was some kind of inflammation in him, but this was an intuitive thing.  He had a metal plate in his leg which had been there for 22 ish years.....perhaps his body was fighting it?  no idea what his homocystene levels were or cholesterol....would he have had high cholesterol to have had soft plaque in the cicumflex artery?  He told me only a few months before that his BP was 'normal' - though i don't know what the readings were.

The myocardium had a 'defect,' - yellowing and mottling....and it was around this area there was a rupture.  The coroner suggested an original MI a few days before weakened the area and led to the rupture days later.  I wonder if the defect was due to him having rheumatic fever as a child.

It's scary to think he was acting larger than life and all the while this time bomb was waiting to go off and there were no symptoms.  It's also scary to think that the doctors don't really have any way of checking me.  They are refusing to see me and do any further tests....saying they cannot justify it with my current level of risk.

but i'm writing this really to talk about my dad.  From this result is it likely he had high cholesterol?  What might have caused the inflammation in the arteries?  His lifestyle of rushing around and eating sugar for energy was bad....but he didn't eat much fat at all.  He didn't exercise for a long period and didn't ever relax...ever.  However he could do the gardening, wheel my grandmother around in a wheelchair....jog around the town from shop to shop (short bursts though, but people always commented on this)....never had chest pain..

How might this have been picked up?  If i could turn back the clock (which i can't) how might we have known what was wrong with him?  What tests might hve revealed it?  I didn't think a stress test would have revealed anything, but judging by these results maybe it would have...?

thanks for listening, sorry i've written loads...

[Rosemary349]

I won't keep posting this up but really would value any further thoughts on the first post about the coroner's report.  (just posting this up again in case it wasn't seen by many)

thanks :-)

[Rosemary349]

anyone with any further thoughts/expertise on my first posting about the coroner's report?

[Rosemary349]

Thanks for your reply.  I am glad you have access to good education and support and i really really appreciate your time in responding to me.

I live in the UK, here i think there seems to be very little done to prevent heart disease.  I mean recently we had an advert on tv telling us how to spot the signs of a stroke....but never anything about heart attacks.  Also what happened to my dad, it's a picture that they know about...first infarction (minor) that leads to later rupture because it was ignored.  They also know that it's not uncommon for epigastric discomfort to be a heart attack, yet the general public do not know this and it is not taught.

I also wonder why patients are not invited along or encouraged to go along for a routine cholesterol and blood pressure check.  Where i am it's not emphasised at all.  If it were i'd have picked up on it straight away even if my dad didn't cos i always had an interest in these things.

My mum is now on statins.  Her cholesterol is good but she has high bp and smokes, so they are offerring it as a prevention measure.  That is good but this has only happened because she went along for a check up  because of my dad's death.  She wasn't encouraged or invited along.  Family have said to me that it's about personal responsibility and I agree up to a point.  First of all someone has to have been taught something before they can take action.

I am so glad you are volunteering your time for others and offerring education and thanks again for your reply.  :-)

[Flycaster305]

It is confusing, but it's been described to me that Cholesterol builds up under a lining in the heart artery over a long period of time.  This causes the artery to form a narrowed channel.  Inflammation may occur, and the bulge ruptures.  This causes cells to race in to repair the damage, causes the block.  Sometimes the bulge simply gets gets big enough to stop the flow of blood, but over a long period of time, and small arteries grow larger and can handle the load.  

My blockages have all come on very quickly, that's why I have had multiple heart attacks.  They always came on when I was either very angry, or suddenty  increased my physical activity level.

It's not a black and white, either/or issue.  I would disagree that there hasn't been research and education.  I work as a volunteer in a cardiac ward, and talk with patients and families about the importance of diet, exercise, cholesterol control, etc., and always stress the huge amount of progress that has been made with repairing hearts, and that the emphasis upon exercise, diet, cholesterol control by the medical and insurance companies has cut the percentage of heart attacks down every year.  

[Rosemary349]

Hi Flycaster!

Thanks for your reply.  I understand these things just happen, however it's about knowing why thee is a blockage in the first place....these things don't happen to children as a general rule.  What the hell is it that is clogging up our arteries?  I mean, they say it's sat fat....but there is now evidence that it's sugar that's the bigger problem, leading to metabolic syndrome, etc.....then there's inflammation....

it's complicated but in the midst of that complication i think there should be some informed guidance.  I really don't think enough is being done.  There is more campaining for other diseases.  I think the advice the public gets is so minimal it's criminal.

[Rosemary349]

Hi Ed!

thanks for your reply and I am really sorry to hear about your mum.  I've read about that before somewhere but don't think i acknowledged it as it wasn't a thread i was in.  

It seems a shame we have to go through stuff before learning.....why doesn't someone teach us this stuff beforehand?  I know not everyone listens but some of us do.  If i have listened to my gut I would have called an ambulance two days before dad died.  He'd gone to bed with 'indigestion.'  He said there was no chest pain, only stomach discomfort.  He got up later to work and carried on as normal....it was because he got up and insisted he was alright that i didn't call anyone.  I did call a helpline though and they have apologised for insufficient assessment and not listening to my concerns.

How amazing that the medical profession don't know themselves....I had a doctor listen to my chest with a stethoscope and say there's nothing wrong with my heart.....like that really can give back a lot of information.  I understand if the tests they can do are limited, but just admit it, tell me the limitations, don't pretend to have some expert knowledge that i must blindly trust.....

and why isn't there a national cholesterol screening programme?

[ed34]

I think that a lot of it depends on the persons activity level. Working in the building trade at the time, I was noticing all typical symptoms and the high level of exercise is probably what enabled me to survive (according to my cardiologist). If I was doing a desk job with little exertion, they believe that I would not have noticed things going wrong until it was too late and my heart wouldn't have adapted to cope as it did. A tractor with many problems will happily idle and the problems won't be apparent until it's expected to pull a heavy trailer. Many people who lead inactive lives have no idea what is happening to their hearts because they are in a relaxed state most of the time. If they do feel anxious, which can present problematic symptoms, most Doctors simply mask them with anti-depressants etc.
Another thing to consider is fear. My Mother was getting very short of breath with small walks and you could see she was getting chest pains, but would never admit it through fear of hospitals and surgery. Five years ago she was breathing very heavy and I had enough, I called an ambulance. Lots of Doctors looked her over and her ECG was normal. They put it down to a chest infection. I was told to go home and return in the morning. The following morning I phoned to see what ward she was admitted to, but nobody could find her name. I drove there annoyed, thinking they had messed up their paperwork. I went to ER and asked where they had moved her to, which ward, and I was asked to wait in a small office. A Nurse appeared and she was holding a bereavement leaflet, so then I knew. Her heart stopped during the night and they couldn't restart it. Post mortem revealed blockages in her LAD and had been building up for a long time. If I knew 5 years ago what I know now, I would have demanded an angiogram and she would probably be here today. It is good to gain knowledge in such fields as it can be very useful in helping others. I noticed my wifes friend was very short of breath walking up a slight hill, she said how her throat felt strange, so I suggested she get her Doctor to refer her to a Cardiologist. The Cardiologist did an echo and something was wrong so an angiogram was performed. She had a blockage of 90% in her circumflex which was successfully stented and she no longer has any symptoms. Keep learning as you are, it will have a use one day.

[Flycaster305]

Rosemary, you might simplify things by comparing your father's passing to what happened to Tim Russett last year.  He had been recently to his doctor, but had a massive heart attack.  As I recall, he had some cholesterol blockage, and a blood clot lodged in the narrowed space.  Sometimes, these things just happen even though we live in an age where medical advances are ocurring rapidly.  

It sounds like your father was lively right up the end of life and loved and was loved, did well for himself, and that is indeed a reason to rejoice!

[Rosemary349]

Anyone else have any thoughts on the report?  My primary physician will discuss it with me next week but wondering about it now...

thanks!  :-)

[Rosemary349]

thanks for your reply.  I forgot my password and couldn't reply sooner.

Hope you are ok too!  Thanks for your thoughts, I did actually think (before he died) funnily enough that he must have a high homocystene level.....but i wasn't thinking of heart disease at the time i was thinking of his arthritis....

thanks again for your reply

[Rosemary349]

the report also stated tha tthe mitral value showed some moderate mucoid degeneration and the aortic valve showed some calcification.

There was also moderate pulmonary oedema and congestion, but no evidence of pumonary embolism, infarction, mass lesion or pneumonia.

Are these findings signficant or incidental?

thanks

[ireneo]

It's good to hear from you. Sorry the report took so long to get to you. Imagine waiting all this time wondering. The initial shock of his death was bad enough.

Our bodies make cholesterol; it's not all from food. I'm not sure what his blood work showed over the years. They're finding inflammation is hard on the heart. I'm not clear what causes it, perhaps stress and all the cortisol circulating through the body.

Rheumatic fever can cause heart damage. Maybe it wasn't noticeable at the time but add aging and stress, it may have been just enough to cause a weakness in the heart.

As for testing, I think angiograms are the ultimate for finding blockages. But doctors don't order those without some reason like angina or a heart attack. It's so invasive a procedure. If your Dad was feeling OK, he wouldn't have mentioned anything to his doctor. As for slowing down, he probably wrote it off as getting older, not poor circulation and fatigue from that.

I hope you're doing OK. My Dad's 2 year "anniversary" of his death is next week. It's easier to think about him, remember things but it would be nice to have him near by to hug again.