Confused about Heart Cath and Findings and abnormal EKG

[MaryRoe]

Dr.Doctor.

After 4 years of severe non exercise angina, an area finally showed on Adenosine Cardiolite in August.  Previous Cardiolite in 2002 never showed a thing. Cardio said to return in 3 years. Thank God, I did not listen.  Seeing a female doc on TV gave me the gump to get feisty with a doctor. She said my mouth saved my life.

Heart Cath showed 99% blockage in mid LAD (this area only showed on Cardiolite prompting heart cath)

70% was seen in RCA with areas of 50% scattered in the RCA. 70% area never showed up on Cardiolite. All stented.

Told all blockages stented until 2 weeks later, when severe angina returned and another cardiolite showed residual distal LAD stenosis. I was shocked to learn I left Cath room with blockages remaining. Told to wait 3 months for repeat Cadioloite and this should all be normal

New Cardiolite still shows the distal Lad blocked.  He used the word Athitic area? He said vessel was too small to stent or by-pass and it will remain "clogged". He used the word "a lil tip touching the heart".  I am concerned.  

I had reaction to Fentynal/versed during Cath and trashed on the table. They will not do another Cath on me as these meds are best for a Cath, was told.

Would a Cardiac Perfusion MRI help in seeing stenosis left in the distal LAD?  Blood Flow test?

Echo is normal with EF around 70%. But, 4 EKG's show Septal MI. Docs are puzzled as no findings of an MI seen anywhere.

Could this be a normal finding in some?

On Plavix,TopolXL, aspirin, Crestor,Ace. BP good.

Needing some peace of mind.  Thank You, Doctor.

[CCF-M.D.-MJM]

Hi Mary,

Let me make sure I understand the question.  You have a positive stress test after you have already been revascularized with stents.  The area of in question is in the distal LAD territory of the heart and your doctor thinkgs the vessel is too small to benefit from stenting or surgical bypass?

Yes, this can happen.  There can be areas of the heart that are narrow but too small to benefit from a stent or angioplasty.  Unfortunately, without seeing the actual film I cannot say if this is true or not.

Having a reaction to sedatives (fentanyl and versed) happens sometimes, but is not a contraindication to another catheterization.  There are other medications that be used, although not as convenient.

If the cath shows the distal LAD lacking targets, there is no added benefit to an MRI or any other sort of stress test.

You are on some good medications now which will likely help.

I hope this helps

[MaryRoe]

Apparently, the stent doc stented the Mid LAD but unable to get all the way down into the distal.  2 weeks after the stent a cardiolite was done and I was told residual stenosis was still seen in the distal LAD area. They said to repeat a cardiolite in 3 months.  A repeat cardiolite 3 months later (last week) show stenosis still in the distal.  I was told I was born with too small of vessels and no stent or by-pass would help.  I never saw any of the pictures either even though I did ask.

I personally think another Cath is in order with different types of sedatives so I know my prognosis.

Thank You for commenting on my tale of woe.   I am back to square one, I fear, since we cannot see the pictures.

God Bless.

[CCF-M.D.-MJM]

MaryRoe,

You mentioned you wanted to know your prognosis.  Left heart caths predictive of prognosis unless you have proximal, not distal disese (disease) (like you have).  A more predictive test is a simple exercise stress test.  The data for angioplasty and stenting supports improvement of symptoms, not prognosis.  

This may be a contorted way of thinking about it, but cardiologist will cath just about anyone if they can find a reason.  If your doctor is reticent to cath you, don't go poking the skunk--there is probably not a good medical reason to repeat the cath.

[hankstar]

Hi,

  You sure follow directions well, Glad to see you got to post your question through, you appear to be a very persistent person. If you had your cath and stent in Houston, this is where we send our patients to get cath, stented and open heart surgery done, they are rated some of the best in your country,I live overseas, and Houston, Texas is a closer destination, of course CCF is probably rated the best heart centre in the country , if not the world!

I think they did all that can be done for you at present, some ECGs will always be abnormal and suggest things that are not present, for example they are infamous or famous for continuously diagnosing left ventricluar hypertrophy in some patients when an echo has continually ruled out that hypertrophy is not present, that being the "gold standard for diagnosing hypertrophy". So I would trust the other test. They are just arteries or certain places in the artery that just don't warrant further treatment. Sometimes I know only you know your feelings, but sometimes it is also best to leave well alone.

You are on good medications for your problem and for protecting future events, I almost hate to mention this but I will anyway, maybe you could ask your doctor if he thinks Lipitor might be just as beneficial in your case as Crestor without the side effects, just a thought , not putting down Crestor, Lipitor has been around longer so the side effects are much more established.

I hope that the anxiety of discovering you had a real problem that was being ignored and then discovered is not adding or contributing to your symptoms now and letting those ECGs that suggest MI interfere with your positive outlook, you were one of the fortunate ones to have found out in time.

  Rarely does one see an EF of 70% with a previous MI, luckily for you this was caught before a real MI could take place and caused damage to your heart.

  Take care and all the best for the Holidays and a Happy New Year.

    Hank.

P.S. Please note these are my personal opinions only , always trust your doctor or seek a second opinion  if in doubt.

[MaryRoe]

Thanks for the added comments.  yes, Hank I am peristant when I feel I do not have all the facts.  (-:  I followed your advice to the tee. (-: and I was able to log on.

I think everyone knows me at the THI/TMC (-: but in a very nice way.  I had a horrid reaction to the Fentynal/Versed in the Cath Lab and they almost gave up on me. They had no idea at that time I was having a reaction to the meds. )-:

Even the Taxus stent was not deploying correctly but my Angel never left my side.  She helped them correct it.

I like the stent doc very much but his partner who is my regular cardio doc is solumn faced and never smiles. This concerns me. It is gloom and doom outlook whereas the Stent Doctor is upbeat and laughs outloud thus making patients feel comfortable. The communication with him is so much better than with his colleague, my Cardio Doctor. I would love to only see the Stent Doctor (interventional/general cardiologist) but I do not want to hurt the other one's feelings.

I am sooo hoping to build collaterals by extensive cardiac rehab that I attend 3 days a week and also a Yoga class one day a week and walking every evening for 2 miles.  I am exhausted from all this exercise/rehab. (-:

We have a 4 year old (adopted) that I would like to be around for her, a long time. God helps those who help themselves so by stocking up and being an informed patient about one's medical condition, is the Mercedes of Good Health Care.

Hank, you know so much and write well, are you sure you are not a doctor of "something".

God Bless You Both,

[MaryRoe]

Add on for Hank,

I received an e-mail from my Bro-in-Law, Ph.D, yesterday also concerned abouth the Crestor and the recent news out about Crestor and also "the unknowns" about this drug.

With Lipitor and Zorcor and pravachol, I had untolerable side effects with Lipitor being the worst for me.  With Crestor..nothing..nada...no side effects.

After 6 weeks on 5mg. Crestor and getting my TSH down into the .090 range, T.Cholesterol is 180 (never had it below 220)
LDL is 87 (never had it below 135)   Never had a problem with Tryglerides(always in the 100-130 range) HDL was 48 (need to get this up to 55 or better)

I hope all the rumors on Crestor prove false.  It has been a good drug for "me".

Thanks for the concern.

~~~~~~~~~~~~~~~~HAPPY HOLIDAYS~~~~~~~~~~~~~~~~~~

[hankstar]

Thanks for the kind words. I bet you'll do just fine. If the Crestor works and you suffer no side effects , then stick with it,we all respond differently, unless something unusual develops.

There is older statin that is rarely used now, but probably one with the least side effects, Mevacor(lovastatin).

One can be a doctor of so many things without the actual MD behind the name.

I'll give you a little tip sometimes a doctor with a straight face that never smiles or jokes, what they often refer to as " a poor bedside manner" is usually the best the doctor, of course a smile and cheerful look can go along way in providing a patient with confidence in a doctor,that is not to say that a a cheerful doc can't be the best either.

Take care , wishing you well and Happy Holidays once again.

[MaryRoe]

Thanks Hank again.

Yes, I have to agree that one does not have to have M.D. after their name for Good Ole Common Sense (-:  Mama told me this, years ago.  She was an RN and head supervisor in a hospital for many many years in the East.

One thing the stent doctor told me was I would die from a bus running over me.  (-:  Better be a big bus as I have a pretty strong willed body.

Wishing you a Safe and Happy Holiday.  I am ready for Santa. (-:

On another note:   Texas vs Michigan in the Rose Bowl.  Yeah!~!

~~~~~~~~~~~~~~~~~Love both teams!!!!~~~~~~~~~~~~~~~~~~~~~~

[MaryRoe]

The doctor who never smiles called me yesterday afternoon and has scheduled another Heart Cath with Dr. Smiley face.

He is also calling in a Cardiac Anesthesiolgist this time so they can have a 'good' look without me trashing all over the table, like before.

I was fired from the Rehab yesterday with low degree chest pains and am not allowed back until I am cleared.

Doctor said 'we need peace of mind'.  I agree.

[hankstar]

Hello,

  Hope everything works out fine with the heart cath, don't be surprised if nothing significant is found.

  I wonder if by some chance you might be having coronary spasms, you might wish to ask your doc about this possiblitiy, on  the other hand , I hate to say this but it might anxiety due to your awareness that you had a problem and was told one was not fixed , lingering subconscious doubt can cause this, I've seen it happen to several heart patients, sometimes with symptoms more debilitating than before the problem was corrected.

Best wishes and Good luck.

        Hank.

[MaryRoe]

Hi Hank.

I had the heart cath and the doc stented the areas in the RCA that he did not stent in August i.e. one 50% and one 40% as he took some measurements of sorts and he mentioned a number under 75%.  Not clear on this. he also mentioned that I did not need this Cath.  Gads...I did not ask for it.

He said the LAD though, looked great where he stented this in August and the distal looked wider.

The whole RCA seems stented now and wide open.  But, unlike the other heart cath a few months back, I feel awful.  I came home with a fever and sick to my stomach and Reflux like I have never known and I am very lightheaded, nauseated and have some chest discomfort when I walk.  I will NEVER be Cath'd again.

The doctor mentioned also that I would never need another Cath.  He did not have to tell me this.  I hate this feeling.

Thanks Hank for your kind support.

[MaryRoe]

Meant to mention this in my last post.  Yes, Microvascular angina in the distal was mentioned.  I had mentioned this to them 3 LONG years ago. (-: after seeing myself on this site and Brigham and Women's site.

Come to think about it you may be right.  My dizziness and nausea and feeling like *&%^%$&^98 may all be nerves. Time heals all.  I do not want to see the doctors again for a longggg longgg time.  They did have me scheduled for a Cardiac MRI before I left the hospital but I felt tooo lousy to get it.  I get this on Thursday if I can drive.

God Bless.

[hankstar]

Hope you feel better soon and your symptoms soon disappear, glad to know to you made through the cath okay despite not feeling well afterward, though if you didn't report the fever and nausea to your doc, you should have.

usually nothing is done to blockages unless they are more than 60%, besides drug therapy and recommendations of a healthy lifestyle.

Take care, best wishes, and Happy Holidays.

    Hank.

[3rd timesacharm]

Hello All,
tomorrow at 2pm pst I am having my 3rd heart  cath and I am scared to death.  I had one about 3 years ago after a MI a light one though it was, they found that I had blockage at the back of the heart. Then about 5 days later the stent closed down and I had another one.  This MI hurt way more than the first one.  Oh man did it hurt.  Then after all that I had complications after the cath.  I had to pee and when they tried to turn me over the artery popped and I lost 2 pints and blood went up to the ceiling.  I lost so much blood that I had to have a transfusion.  I started feeling like I was no longer well about a month ago so they scheduled me for a persantine cardiolite and found out that I needed another cath in the left ventricular front part.  They said this would be easier to get to.  They said I would be in for 15 minutes.  They have taken me off of the coumadin that I was on and I am worried about an embolism which I also had the last time that this happened.  I also had an infection in the groin site.  So much so much.  What do I need to look for.  I am  havin light angina.  I would like to be reassured but I would also like to know the truth about what I need to know.  So if anyone has any input let me know.  I am stressed to no end.  Thank you .