Clogged Arteries

[lolathechi]

Hi

I was wondering what are the symptons of clogged arteries? Is a stress test used to determine that? If your arteries are begining to clog can this reverse with diet and exercise?

Also they say the vagus nerve is related to a lot of pvcs, if this is so why dont they have a medication that will "relax" your vagus nerve to stop these horrible things??

Thanks so much!

[Cleveland Clinic]

lola,

thanks for the post.

The arteries of the heart supply blood to the hearts muscle.  When these arteries become blocked with cholesterol buildup, or with a blood clot in a heart attack the symptoms are usually chest pain or chest pressure. Some people also have pain in their arm or throat, back pain, nausea, or sweating.  Any new symptom that you  are concerned about you should review with your physicans or health care providers.

The Vagus nerve controls a lot of the body functions apart from heart rate and rhythm. Unfortunately, not all PVCs originate from the Vagus nervous system, nor is there a good way to 'quiet down' the cardiac portion of it.

good luck

[yellowrose]

very good question, i want to know that to, seems like when acid reflux acting up pvc/pac are lot more. i had a treadmill stress test and failed it, so had a heart scan and a echo just done, thats how they told if i had a clot but they said mine was clear, but also told if your not 70 precent clogged they cant see that on a heart scan or echo . good luck with question hope you get your answer.

[EchoTech]

Ther are many signs of clogged arteries including, but not limited to: chest pain, back pain, left and sometimes right arm pain, a sense of doom, profuse sweating for no reason, jaw pain, shortness of breath, chest pain with activity that goes away when you sit down, tiredness, etc.  There are several different kinds of stress tests that can be used to detect clogged arteries, along with a catherization where they inject dye into your coronaries and see if there are any blockages.
  You can help control clogged arteries with diet and exercise, but it is not something you can cure.  There maybe other factors that are causing your clogged arteries, but without knowing a lot more information, it would be just guessing.
  As far as PVCs, that's out of my realm of expertise.

For yellowrose, I hope you are seeing a cardiologist for some management and not letting your primary doctor act as a cardiologist.  My personal opinion is that if you failed the treadmill, you need to see a cardiologist and not let the primary doctor run the show.  There have been multiple times over my career that I have seen general practioneers try to practice cardiology, and invariably that patients seem to suffer and have a much less desirable outcome.   One case that comes to mind is a patient that had chest pain 10 years ago and his doctor put him on nitro pills.  Nitro pills are good in when used on conjunction withseveral other therapies and procedures, but this was his only treatment.  this patient only had nitro pills and the end result was that by the time a cardiologist saw him, there was nothing to do except to try to amke him more comfortable.  Intervention years before by  acardiologist would have in great probility extended the quality of life and the years he had on this planet.  This is my personal lay opinion and is not that of a board certified cardiologist.  
  Always remember, you pay the bills, so you are the boss.  You can tell the doctor what to do with how you want to pursue your treatment.  It pays to see a specialist.  

[HAMMERHEAD]

DOES ANYBODY KNOW HOW OFTEN SHOULD YOU HAVE A STRESS TEST? I'VE HAD 3 ALL DIFFERENT KINDS AND THEY FIND NOTHING. ALL THREE WERE DONE BY DIFFERENT PEOPLE. THEY SAY PAIN AND SYSTOMS ARE ANXIETY. MY BLOOD TEST COME BACK GOOD. THANKS!!!!!

[yellowrose]

i do go to a cardio group and they did the test, would not go to just any dr for my heart. darn pvc/pac just wont go away so tomorrow going to wear a month long event montor see whats up with them . but i know that when my acid reflux is bad they seem to be worse and lots more of them, sometimes i wonder if its just spasms from that and not the heart but other times i have the stronge beat after the flutter so guess they come together. have had them over 20 years were not bad but since acid reflux came to live with me they want to be there to keep it company, so learning to deal with it all over. hope all has a pap free day

[axg9504]

I believe there is only one affirmative way to verify clogged arteries and that is a heart cath..

[line]

I was wondering also if the echo could show blockages, wouldn't your blood flow be low if
there were blockages?

My husband had a heart attack 7 weeks ago, he had a cath and was 100% and 80% blocked. He showed no symtons, no s.o.b. tiredness, nothing. Had a thallium stress done less than 3 years ago and a stress done within the last year, he passed them both, no problem.

The cardio told us because he was in such good physical state is the reason he showed no symtons. He woke up at 1 a.m. with severe chest pain, I called 911 and he passed out. I am not certain about these tests. I know other people who had false neg. and false positive with these tests.

Line

[MinnieM]

Hi, I know you are not the doctor.  I am having echo's every month due to a heart event.  Echo's were normal prior to this A-FIB heart event a few months ago.  Post event they now show a gradient of 50, then 40 and then 30 and the last two are stuck at 18mmHG. Still shows dynamic LVOT obstuction due to SAM. These echo's are in the cardio's office with a tech who has been doing them for 8 years.  She tells the doctor the results and he tells me. (he is an echocardiographer doctor)  Can errors be made on these Echo's and perhaps a gradient is really not seen?  My EF is always >60%.  Thanks, Echo Tec.  I am scheduled for another Echo in 2 weeks.  Getting weary of all these echo's.  Also, would a TEE be more definitive.  Again, I know you are not the doctor but I do value a Good Tech's expertise. Thanks

[EchoTech]

I'm not all that great with arrhythmias so I'll give a somewhat educated guess.  Some people feel the skip beats more so than others.  There is  no rhyme  or reason as to who can feel it and who cannot.  I don't have a really good reason for it.  The best analogy I've come up with people and pain tolerance.  There are some cry after a needle stick, while others are like no big deal.  These same people that can't take a needle stick, you could crack a 2x4 board across their back and it won't even stun them, while the other folks crumble like a pile of bricks when you hit them.  Everyone is different in their tolerance, and sometimes it changes over time.  sometimes stress can aggravate the arrythmia, but then you already knew that.

[EchoTech]

Well, I'm not sure what event you might be talking about.  I'm going to guess you had a-fib and then discovered the SAM.  I'll also guess that they put you on  a beta blocker to help with the SAM.  It sounds like that they are watching to see if it is reducing the gradient which it seem  like it is.  With the same tech doing them month after month, the likelyhood of her seeing them at first and then missing them now are quite remote.  If the pictures were extremely difficult to see, perhaps, but since the tech got the gradients the first three times along with the other two lower ones, that would be stretching it very very far.  In all likelyhood, they are getting the same quality pictures and measuring in the same place they were before and that they are truly measuring the gradient correctly.  They can use a cath to get the gradient, but they'd likely prefer to do the serial echos.  As far as a TEE, the short answer is that a TEE would not be the test of choice for measuring what you need.  There is a reason for it, but it would really be bogging you down in details.

[cryingheart]

The symptoms of clotted arteries are the symptoms of a HEART ATTACK OR STROKE. If you are having those symptoms you need to be seen. A stress test is usually not done if doctors are thinking you may already have a blockage. A stress test if positive can indicate narrowing of the arteries as in plaque build up and harding of the arteries.

[MinnieM]

Thanks Echotech for responding.

Echo's were done in late 2004 and one in 3/2005.  These due to a heart cath and stent in summer of 2004.  ALL Normal Echo's. EF 60%.

Spring, 2005, A-Fib attack (first one ever). ER conversion to NSR. Normal heart Enzymes in ER.  4 hrs later elevated Troponin (4.3) levels and CK-MB. CK-MB quickly came down.  Troponin took 4 days to hit the normal. Heart Cath showed small blockage in LAD that was not stented in summer 2004 so they stented this even though Cath doctor did not think it was the cause of the A-Fib. Cath doctor called this a "heart Event".  He said no MI but Echo doctor disagrees and is going by the Troponin spill. Cath doctor still disagrees with Echo doctor.  "hatfield and mcCoys"  LOL  

Then post-"heart event" Echo now shows Dynamic LVOT Obstruction due to SAM.  This concerns Echo cardio doc. From a 50 gradient in June, July was 40, August was 30 and in August again, 18 and the other day still an 18mmHG gradient. Echo cardio doc  wants this back to normal ASAP.  Replaced TopolXL with Coreg.  On Plavix also.  A-fib, I heard can cause a spill of Troponin which means some muscle involvement.  Will have another Echo in 10 days to see if Coreg is working.  My feelings is this Echo may never get normal. )-:  I am praying very hard.

[upbeat63]

Hello, just wanted to ask a question of you, regarding any earlier post you made about GPs and cardiologists.

Brief history. I had a stress echo done after a 48hr holter showed I was having 24,000PVC/day, about 20% of my heart beats. I asked my family doctor for the echo, because I've had PVCs for 24 years and this was a significant increase. Family dr hadn't recommended anything except toperol. I was concerned about a possible cardiomyopathy

Long story short, she then ordered a stress echo and dopler. But the report was so "lean" that I called the center that did the tests and asked for some information on the measurement of the LV and EF. The tech asked why I wanted to know all this when everything is "normal" (except mild aortic regurge). I said I wanted a  baseline and thought EF was always given with a stress echo. She said no its not and that to review it again and calculate figures more would cost more. I already paid $700 out of pocket for this in addition to $650 for the holter and $400 for my family dr appnts.

So finally, my question. What is standard info to provide in the stress echo with dopler. There was only one sentence I didn't understand it was something about a rate pressure. I have the numbers, but didn't know what if anything it means, and it was buried between regular, normal and other descriptions of heart wall motion-- meaning --tell her to go get a life--...I haven't seen a cardiologist. The report went to my family doctor and they faxed it to me. Is there some bias there? Would I have gotten more info with the cardio? No one seems concerned and I certainly don't want to spend more money to "chase butterflies" when there's nothing there. Thanks for your opinion.

[EchoTech]

Well, the way I would look at it is that you may have, and heavily stress the MAY, have had a heart attack.  If you EF is 60% (normal is 55%) and you feel fine and can do what you want to do, then I would not sweat it.  I was wondering if the gradient you mention is the peak or mean gradient.  If your peak gradient is 18 mmHg, then that is reaaly close to normal.  If you mean gradient is 18 mmHg, then hopefully it will come down some more.  By reducing the graident, you have most likely improved you mortality and morbidity rates, and that is a good thing.  I hope things go well for you.

[EchoTech]

Well, that's an interesting situation.  I would lean in the direction of if the report says everything is normal except for the aortic regurge, then I would relax. Different centers have slightly different ways of doing things (they mostly get the same info), but cardiology in general is slowly moving towrds standardizing reports from hospital to hospital. The center I work at we do not regularly calculate the EF on the stress tests.  The best way to expain it is that in the stress testing realm, we think in terms of normal vs abnormal performance.  If there were abnormalities, then cardiologists think more in terms of what vessel may be partial/completely blocked vs. what is the EF? It seems to confuse people when they have a normal test and are told that the EF is normal at both 55% at rest  and 75% after exercise.  They seem to see the large gap in the numbers and think that their resting EF should be 75% instead of 55% and that it is a problem.  It isn't, and it seems to get people more confused than reassured. We visuallly look at the heart wall contractions to make sure that all the walls contract stronger and more vigorously after you are done on the treadmill.lculate the EF and LV meaurements, but I can't see why it would cost more.  There is someime involved in calculating the values, but it really shouldn't take more than 15 minutes or so.  If you have some concerns, I would try to talking her supervisor, and just explain the situation, and I'm pretty confident you can get the extra information without too much trouble.  hospital management is very big on customer service, and they'll try to please you as much as possible within reason.

  I think you would have gotten more of an explaination with a cardiologist.  It would seem that the stress test in general was normal so that they are not worried about it.  It is always your right to seek a second opinion if you want to.  I personally wouldn't but that's just me talking, and I'm certainly no doctor.  I hope this clears some of it up or  I can try to explain it in  adifferent way.

[upbeat63]

Thank you for your information. I'm trying my best to accept what I have been told so far, benign PVCs, no abnormal heart wall motion, mild aortic regurge, normal, normal, normal. But when you ask questions and get a pat on the head I guess it's normal to feel something is lacking.

And when you get 20 PVCs per minute and sometimes more, feel a little lightheaded and fatigued, you start the questions all over again. It's a vicious circle that has few breaks. Thankfully there are breaks and I'm trying to take full advantage of them when they come. Thank you again, you are a special person to assist so many with your knowledge.

[upbeat63]

Just one more question of you please. I read my stress echo report again and it said trivial aortic insufficiency, not regurg. Is that the same thing or are they describing different circumstances.  I know you are not a doctor, but your opinion and information regarding these tests are greatly appreciated.

[save]

I have read your comments and greatly respect them.  You responded to a question  that I had ask one of the Dr. before.  I do have blockage.  I have been exercising for along time, and my symptoms increased a lot this past year. I have seen a cardiologist and he increased meds.  I never exercise without symptoms that can get severe.  I get chest pressure/squeezing, jaw pain sometimes the right upper part of the arm.  I now wear 0.4 Nitro Patch, plus I have started using the Nitro pill while I am on the treadmill ( this was my idea)  if the symptoms get too bad.   The symptoms let up when I stop, and I  go on to lift weights.  Later - maybe an hour or more - I seem to sometimes get pressure in the chest that really bothers me - not always.  I don't understand  what happens.  Nitro pills do help when this happens and  laying down.  The pressure continues if I walk around.  It is hard to understand CAD symptoms.  On a stress test that I took, I was told that my heart was slow to recover.  Would this make a difference?     I seem to get a lot of chest pressue lately.  I am the person that wrote about 5 blockages and was told at first surgery (because he could not stent the ones (2) that really need it and then changed to stenting the 3 that are not life threatening because of symptoms.  He said that he could not guarantee this would stop symptoms.  So, I decided not to do the stenting.

[MinnieM]

Thanks Echo.  Yes, I am on Beta Blockers.  First TopolXL up to 75mg and the gradient was not coming down fast enough (my thoughts) and he switched me to 12.5 x 2 a day of Coreg.  I nearly croaked on that amoutn so reduced to 6.5 x 2 a day and hated this as well so a phone call told me to get back on the TOPOLXL till he seesz me next week.  

I am not sure what my Gradient is:  mean or "what was the other things you mentioned". It is not listed anywhere on this report. All it says:(8/10/2005)   DOPPLER FINDINGS "LVOT SV=106ml. LVOT CO =9.3 L/MIN.  Mild (1/4) mitral regurgitation.  Unable to estimate PAP. Estimated RA pressure 5-10 mmHG. Pulmonary vein flow is suggestive of normal left atrial pressure.  

Comments:  A 16 mmHG LVOT gradient noted. Compared with prior study of 7/6/05, no significant change. Decreased from 6/11/2005 study which showed a 30mmHG gradient.  

Echo, I had another Echi in 9/4/2005 and do not have that report yet but told the gradient has not decreased any further.  This is why the cardio placed me on Coreg but I am unable to handle this.

Is what I am having in his office called a serial echo?  Thanks much.  You are very valuable. My cardio relies so much on the ECHO tech.
I still feel like *&%^%$^* and tire esily.

[EchoTech]

Thank you for the compliment.  I hope things are going better for you.

[EchoTech]

Sorry, I forgot to add that aortic regurgitation is exactly the same thing as aortic insuffieciency, it's just a different name for it.

[EchoTech]

again, I'm not  a doctor, but I think it would be a good idea and share this information with your cardiologist.  If it's been more than a year since you've last seen the haeart doc, I would re-visit him.  I am a little unclear on the stenting vs. surgery.  Usually they'll try to stent vessels unless they are extremely tortuous ( they zig zag  and have a lot of severe curves), the vessel is too small, or it is at a branch artery. As a general rule, plaque in the vessels either stays the same or gets worse. If they can't stent the 2 that are life threatenting, then surgery would be another viable option and the only one that I can think of right now.
  The bottom line is, if it were me, I would either visit with the cardiologist again or get a second opinion from another cardiologist if you don't like the first.  It sure sounds like you need either surgery or the stents, and the relief that you get when you take the nitro just makes me more suspicious.  I would also suggest that you ramp down the exercise until you see the doctor.  
  And for the record, no doctor or surgeon can ever "guarantee" anything.  They are not God and can not give you a 100% prediction on anything.  There is no test out there that is 100% right all the time which is why they do multiple tests to reconfirm and make sure the information is right. You could ask for percentages and/or probabilities of the likely hood of a heart attack or further angina and they percentages that you would make it through procedures and complication rates.  This would help you make a better choice for yourself.  For them to make a statement of a guarantee would just be like them begging to get sued.  Good luck.

[EchoTech]

Well, the test you are having is an echo, but it is done in a serial fashion, so it means that they do one after another, after another, etc. until your cardiologist is satisfied.  There is a difference between the peak and mean gradients, but it sounds like you've stabilized the gradient, so it is quite possible that they might just sit and watch it for a while.  There are some people that take the type of medicine that you are on and it can take a while before you get used to it.  If memory serves me correctly, it can be  anywhere from a few weeks up to six months.  I hope this helps a little bit.

[EchoTech]

I re-read your post from 08/14.  It would appear that your symptoms are worsening and that you did get a second opinion.  It is a high proability that they would recommend open heart surgery again.  I can see them wanting to put it off so that they can do both the  valve surgery and bypasses together instead of doing the bypasses now and then getting valve surgery in a few years.  If it were me (this my lay opinion and I'm not doctor), I would inquire about getting both the valve and the vessels done at the same time.  Surgeons at the facility that I work at do it and it is not a totally uncommon thing to do.  I believe that there is some more risk with replacing the valve a little early, but do you really want to go through open heart surgery twice within five year window?  For the valve surgery they'll probably give you two options.. One is a mechanical valve and another is a bioprosthetic valve.  There are a bunch of considerations advantages/disadvantages with each one, but I suspect they would lean slightly to the mechanical valve with your age being the primary factor.  I hope this helps and if you have any more questions, I'll try to help.

[ednaearl]

A related discussion, neck pain was started.

[vince0202]

A related discussion, questions of heart disease and heart related questions was started.