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Collateral Vein(S) & EF
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Collateral Vein(S) & EF

Would an expert please advise the relationship between the growth
of multiple collateral veins and the EF readings?
Logic would suggest that collaterals may cause a favorable EF
reading when in fact, a patient could have severe blockage.
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10 Comments Post a Comment
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976897_tn?1379171202
I think the best expert on here regarding collaterals is Kenkeith. he is quite knowledgeable on the subject so hopefully he will spot this and just in. For my input, you do realise that collaterals are not veins? They are more like arterioles, tiny arteries. Remember, arteries carry oxygenated blood to living tissue, while veins take away used blood back to the right side of the heart to be sent to the lungs.
I'm not really sure if the EF would be affected by collaterals. I believe if blood flow is adequate in heart tissue, there would be no collaterals. If oxygen lowers, you may develop them to make up for the oxygen loss. When treatment is given, the collaterals will probably shrink back down and close up again. So, collaterals dont act as an additional supply, they simply make up for a loss, meaning the overal balance is the same, or slightly less.
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976897_tn?1379171202
I think i misunderstood your question, sorry. The above still stands but if someone develops a severe blockage then yes, the EF should remain around the same if collaterals form. However, let's say you develop a 95% blockage in the LAD. Not everyone develops collaterals that give the missing 95%, some will only get enough oxygen to keep the heart happy in its relaxed state, i.e. 68bpm. This is what happened to me. My LAD was 100% blocked at the top but thanks to collaterals, enough oxygen was given to keep the tissue alive, but not enough for exertion. They fed into the bottom of the LAD so blood was flowing up the LAD instead of down and the vessel was so thin it could hardly be seen on an angiogram. So not everyone develops collaterals in the same way. Some people develop quite large collaterals, giving enough oxygen for exertion.
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Avatar_m_tn
Thank you ed34! My situation and experience may be quite unique. The "condensed" version is this. I was diagnosed with severe blockage and quickly underwent 4x CABG. One of the cardiologists informed me that 3 were 100% blocked and the other about 50%. All 4 were replaced. No symptoms at all.
Originally diagnosed with blockages in 1995 and was put on Med's. In reviewing the cath procedure notes of 1995, I read where multiple collaterals had formed. My EF was within range and I exhibited little to no symptoms. Logic suggests the collaterals did their thing otherwise, it may have been lights out for me.
A fair non-medical understanding of the formation and growth of collaterals strongly suggests they grow out of near sheer luck. It may be a defensive mechanism the body uses to stay alive however, not all people can grow or, have the ability to grow the collaterals. I have read the Academy of Arts and Science as well as the American Heart Association articles on the subject.
Lacking solid evidence to the contrary, is it fair to say "collaterals" will and can keep you alive IF your body can grow them?  As we know, not every patient has the ability to grow them.
I would really appreciate others chiming in on this matter and, ed 34, once again Thank You.
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976897_tn?1379171202
"Lacking solid evidence to the contrary, is it fair to say "collaterals" will and can keep you alive IF your body can grow them?  As we know, not every patient has the ability to grow them. "

You are correct. I met someone in a heart hospital who lost 30% of his heart tissue because he didn't grow any collaterals. Your case is similar to mine because if we didn't grow them, we wouldn't be here typing in this forum.
There does seem to be a variety of situations with collaterals, such as....
Some people don't grow them. Some people form them but only small enough in diamater to allow heart tissue to remain undamaged at rest. Some people grow fairly large ones and my cardiologist said some are large enough to be teased open to accept a stent, to act as a natural bypass.
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Avatar_f_tn
I was a runner for many years.  In the summer of 2001 I was idly watching TV and checking my pulse and BP when I noticed arrhythmia.  My wife, an RN, was highly alarmed when she listened, and begged me to go to the ER at once (it was Sunday).  There they did the usual (EKG, lab work) and told us my troponin was slightly elevated, but the EKG was normal.  By then my arrhythmia had ceased, and I wanted to go home.  But my wife insisted that I stay overnight, and I reluctantly assented.  By the next morning the troponin level was normal, I had no other symptoms, and I left with the understanding that I'd return Thursday for further testing.

On Thursday I underwent a procedure which involved lying motionless on a table for about 30 minutes.  The table rotated slightly every few seconds, and a substance which I drank allowed a complete picture of my circulatory system to be made.  That afternoon I was told by the cardiologist that they "feared and suspected" blockage.  The following Tuesday I was administered a stress test, which I passed (I was running 2-3 miles daily), but the cardiologist didn't like the level of effort required.  This was followed by a catheterization procedure, which I dimly recall, and then a quintuple bypass and left carotid endarterectomy on Thursday, of which I recall nothing.  I have no memory of signing anything or consenting to surgery, but I assume I did.  At any rate I'd had no pain or symptoms other than the arrhythmia, was running daily during this period, and yet underwent the surgery, with its attendant risks.  And people wonder why healthcare costs are out of control.  

Once I recovered I began researching coronary artery disease and related matters.  That's when I learned about collateral arteries.  When I questioned my cardiologist about them, he confirmed that I did indeed have them, and that he believed my long running career developed them to the point that I could run with 100% blockages in two arteries and my left carotid.

According to one site, everyone has latent collateral arteries.  Exercise of the right type develops them to some extent, depending on the individual.  I radically changed my dietary habits after my surgery, and today, more than eight years later, my arteries are clear, my EF excellent and all my key lab test results superb.  I no longer run, but continue to exercise daily.  I took charge of my health following the surgery, and while my internist/cardiologist and I don't always agree on issues, we eventually come to a consensus on the important things.  

I don't know how helpful this will be, but maybe it'll shed some light on the original question.
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Thank you for sharing your experiences with us, it really was interesting to read. I can't help but wonder if you carried on exercising as you were, without having surgery, if further collaterals would have kicked into action. It would be great if they could develop a drug to force this adaptation process into action.
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