Heart Disease Expert Forum
Collateral Circulation
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Collateral Circulation


  I had a heart attack 4 months ago.  I have 2 vessel disease with
  no reversible damage and about 25% of my heart is not working. I am
  told however that collateral circulation may take place via growth of new veins and improve my heart's performance.
    I have been unable to find any detail on this phenomenon
  and so don't know if there is a good chance of this occurring or not.
  Can you please advise or direct me to sources of information on
  this subject.
  I did find a web site for "Enhanced Extended Counterpulsations" which
  promoted a kind of pressure pads on the legs which forced blood
  through the heart at increased rates and promoted healing.  Is this
  snake-oil medicine or is it legitimate?
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Dear Colin,
Collateral circulation is something our bodies promote themselves in any
tissue that is ischemic (starving for oxygen); ischemia results from
decreased circulation to a bed of tissue (leg, heart, etc.) often because
there is blockage in the artery supplying oxygen and nutrients to that tissue
bed.  Now the way that our bodies 'deals' with or promotes 'collateral' flow is
not completely understood but it is known that some growth factors are somehow
stimulated and literally cause the cells to grow new routes for the blood or
new blood vessels.  We have known for years that the body can do this because
on angiograms of the heart and legs of people with ischemia we can see these
as faint lines or very small blood vessels which fill last in the whole picture.
We even know that they exist before we see them on angiogram and this has to do
with the limitations of our eyes and the equipment.  Currently the only patients
who receive these growth factors as a treatment are in experimental studies that
require the person be quite ill and certainly in a lot of pain.  It is probably
more important for you to concentrate on keeping that one other artery from getting irreversibly
blocked as you say the other two are.  Regardless you need comprehensive cardiac care
that includes aggressive risk factor management(eliminate smoking, reduce weight and cholesterol, exercise every day, etc.)
and medications to help your heart to remodel in the most advantageous way that it can following your heart muscle damage (for instance you should be
considered highly for beta blocker and ace-inhibitor therapy.)  Honestly we in the medical profession are not at all sure how to enhance the patients' ability
to build collateral blood flow however you can read all about what we do know in any medical library by looking up cardiovascular disease or just vascular disease
secondary to atherosclerosis.  As I said before the growth factor therapy trials are starting but are still in the experimental stages and reserved for those patients for which there
is no alternative.  The counterpulsation therapy you speak of has not been scientifically tested, nor proven to be of significant benefit to the patient let alone
proven that the number of collaterals increases with these treatments;it is in these cases that the patient be reminded that this is really a buyer beware type of situation.  On  a final
note I will say that you should first do the therapies that have been scientifically proven and then consider these off-beat unproven therapies at your own risk (wallet and health included.)
Good Luck.  Information provided in the Heart Forum is intended for general informational purposes only, actual diagnosis and treatment can only be made by your physician(s).




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