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Heart Disease (Expert Forum)
Echo shows dynamic obstruction
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Echo shows dynamic obstruction
by MinnieM, Aug 27, 2006 12:00AM
Good morning.
Last year June,2005,I had an acute event and severe a-fib attack.(first ever) A year earlier(2004)the mid LAD was stented(90%) This 2004 stent did not stop severe angina pains.
The Distal LAD(Septal/Apex area)is scarred and cannot be stented. (perhaps small vessels)?
In the 2005 Acute Event,I got another stent, again in the MID LAD(50% blockage). 7 years of Severe ANGINA finally left with that stent.(new cath doctor) BUT,since the June 2005,event, my Echo's now show Dynamic LVOT Obstruction and has remained that way for over a year. I am on Zebeta for this obstruction but it has not helped.(TopolXL has not either) My EF is in the 60's.
Doctor said I do not have HCOM so I cannot have an ablation to reduce this, he said. He seems to think now the distal LAD, where it is more scarred from the last event, is now causing the dynamic LVOT Obstruction by trying to compensate for a small MI in the distal tip of the heart. He mentioned Venturi effect. He said he knows of no other reason for this dynamic obstruction. I fear that over the long haul the obstruction will cause CHF or sudden death.
Doctor, I need your thoughts. I am sure CC has seen this more than my Cardio doctor. I am his first patient with this condition that does not have a HCOM tag on it. Am I a rare case? I asked my Cardio about a TEE but he said it will not show any more.
Would love to hear what can help reduce this obstruction if it is caused by an Acute Heart event and not an HCOM. Over 1 year now & so far no reduction in a 30mmhg obstruct.
Thank You,doctor.
MM
Last year June,2005,I had an acute event and severe a-fib attack.(first ever) A year earlier(2004)the mid LAD was stented(90%) This 2004 stent did not stop severe angina pains.
The Distal LAD(Septal/Apex area)is scarred and cannot be stented. (perhaps small vessels)?
In the 2005 Acute Event,I got another stent, again in the MID LAD(50% blockage). 7 years of Severe ANGINA finally left with that stent.(new cath doctor) BUT,since the June 2005,event, my Echo's now show Dynamic LVOT Obstruction and has remained that way for over a year. I am on Zebeta for this obstruction but it has not helped.(TopolXL has not either) My EF is in the 60's.
Doctor said I do not have HCOM so I cannot have an ablation to reduce this, he said. He seems to think now the distal LAD, where it is more scarred from the last event, is now causing the dynamic LVOT Obstruction by trying to compensate for a small MI in the distal tip of the heart. He mentioned Venturi effect. He said he knows of no other reason for this dynamic obstruction. I fear that over the long haul the obstruction will cause CHF or sudden death.
Doctor, I need your thoughts. I am sure CC has seen this more than my Cardio doctor. I am his first patient with this condition that does not have a HCOM tag on it. Am I a rare case? I asked my Cardio about a TEE but he said it will not show any more.
Would love to hear what can help reduce this obstruction if it is caused by an Acute Heart event and not an HCOM. Over 1 year now & so far no reduction in a 30mmhg obstruct.
Thank You,doctor.
MM
Doctor's Answer
by CCF-M.D.-MJM, Aug 27, 2006 12:00AM
Hi MM,
Sorry to hear about your medical problems. Obstruction of the outflow tract without HOCM is indeed rare. We when see a case, it is always presented at one of our conferences. Usually the ejection fraction is more affected (yours is normal at 60%). An obstructive gradient at rest of 30 mmHg is mild. We would typical try to provoke a higher gradient by having you breathe in amyl nitrate. Decreased preload, blood flowing into the heart before each beat, would increase the obstruction is probably why you are so symptotic with atrial fibrillation.
It may be worth a trip to a larger medical center for a second opintion. If you come to the CC, Dr. Harry Lever, Thamilarison, Williams, Askari, among others would be very willing to help if they can. Again, I am only familiar with our internal people and don't know where you live, else I would try to recommend someone near you if I new someone. If your note sure you are being managed correctly, obtain a second opinion from someone that sees the condition more often. Your doctor may be right, but it is worth checking.
I hope this helps. Good luck and thanks for posting.
Sorry to hear about your medical problems. Obstruction of the outflow tract without HOCM is indeed rare. We when see a case, it is always presented at one of our conferences. Usually the ejection fraction is more affected (yours is normal at 60%). An obstructive gradient at rest of 30 mmHg is mild. We would typical try to provoke a higher gradient by having you breathe in amyl nitrate. Decreased preload, blood flowing into the heart before each beat, would increase the obstruction is probably why you are so symptotic with atrial fibrillation.
It may be worth a trip to a larger medical center for a second opintion. If you come to the CC, Dr. Harry Lever, Thamilarison, Williams, Askari, among others would be very willing to help if they can. Again, I am only familiar with our internal people and don't know where you live, else I would try to recommend someone near you if I new someone. If your note sure you are being managed correctly, obtain a second opinion from someone that sees the condition more often. Your doctor may be right, but it is worth checking.
I hope this helps. Good luck and thanks for posting.
Thanks so much for this, doctor.
Do you guys help folks who are uninsured, my local Cardiologists will not see me because I am uninsured, I have six great kids a wife and a Suburban, but no insurance, I must say one of my local Cardiologists did say he will see me but bring 800.00 up front, Doc I know the guy needs to make a living and needs to pay his staff but man Thats bold, I guess thats what I get for for being an Indigent, did I spell that correct.
It looks like I will be taking a bus to NYC to get treated, I used to work at Montifiore hospital maybe someone will help there my sister still works there.
Stuart Brandt
I live in a small town in Virginia, the local non profit hospital was just purchased for over 190 million dollars, by Lifepoint Hospitals a for profit Corp.
They have told me dont come back unless you are having chest pains or a heart attack or whatever, I still cant get a stress test, They told me to call DUKE which is about 60 miles from me.
Stuart Brandt