Ejection Fraction

I am just 37 years, no smoking, no drinking , weigh 61Kgs , but strong family history. I had high LDL levels for almost 3 years.
I had an heart attack. I realised what was happening and called in for an ambulance in  20 minutes. The pain was too much, but i still managed to walk to the Ambulance. I was given some tablets an injection and they placed an oxygen mask. They did my ECG and took me straight to the hospital. In hospital not time was wasted and an angiography was done , followed by Angioplasty. All done within 2 hours from the time i was having pain. 10:40 PM i started having pain and 12:50 AM  i was out from the theatre.
They siad i had an heart attack and they have put a stent in LAD. The angiography shows 2, 30% blocks on right side which were left as it is.

My ejection fraction is b/w 60-75. My ECG showed q waves in septal lead; Tropinin I = 18.51, CK = 1083 on the day of attack and came down to I = 0.6 and CK = 110  after 6 days.
I have few questions
1. Is there a damage done to my heart? If yes - can we quantify it? Doctor said that , may be there is no damage done and because i got quick treatment there could be reversal of part of heart muscle that might have starved of oxygen.
2. Can these 30% blocks be a problem for me. I have a very healthy life style and only thing i can blame is my family history.
3. Do i need to continue on all the 5 tablets i have being prescribed for rest of my life? ( Aspirin, Atrovastatin, Clopidgrel, Bisoprolol, Ramipril)
4. Ejection fraction - is this normal range and will i have a normal ECG in future.
5. The recovery time is said to be from 3 - 6 months. What does this mean to me? And will it make me more stronger after that period. I get occassional pains locally in my chest( nothing like heart attack pain), in legs - and i assume it is just a muscle pain. Can this 30% blocks result in such a pain?

[guddoohira]

i read ur post & i can totally identify with it , coz exactly one year ago in May 2009 i was at the same stage as u are in today .
i am 37yrs old , BMI 27.50 (slightly overweight) . Last year May 2009 i had a heart attack . At first i could not make out what it was untill the pain started radiating to back of my left arm . so i was in doctors hand approx. after 5 hours after the pains started . agiography was done & also angioplasty . i had a fully blocked LCX-OM1(branch of left circumflex artery). my numbers , cholestrol 180(good) , TGL 143 (also ok) , HDL-21(tooo low & the part culprit) . no sugar , no hypertension .
finally, they put 1 drug eluted stent . ICU for 2 nights, then normal room for 3 nights & discharged on 5th day .
1. my ejection fraction came to be 55% or above , which doctor stated is good & normal . so urs between 60-75 is absolutely ok & there has been very little or no damage to ur heart muscles .
2. medicines ; yes u have to take as & when doctor tells u to . we both are lucky to not have major issue , but  nevertheless we have a heart disease & we need to take meds .
3. EXERCISE ; shud be the most important routine of ur life now . please join a cardiac
    re-hab programme where they will teach you how to do exercise which will be
    benefitial to ur general & heart health .

Rest all shud fall in it's place in due time. Do well & Take care .

Cheerz

[ed34]

Hi.  With regards to your medication, only time will tell. Aspirin and statins are likely to be a permanent thing to lower your risk of further attacks. If you blood pressure returns to normal, then Ramipril could be stopped, but only time will tell. I had no side effect from that medication and in fact it helps with a lot of things in the body, even the kidneys. Bisoprolol is horrible, I was on it for 2 years. It relaxes your heart preventing it from reacting too much to hormones such as adrenaline. To me it felt like I was wearing a lead weight on my back, everything was much harder to do. My new cardiologist said that due to my EF which is 70%, and no other issues, then I could come off them. I had to ween off, but the difference is amazing. So, I would aim at coming off those when you can.
Your 30% blockages are nothing in reality. Coronary arteries are much wider than they need to be for supplying the heart (even though they are tiny) and there is a huge reserve. If you had blockages of 50% then I doubt if you would even realise it. Besides, the 30% is on the right side which does a lot less work than the left.
Oh sorry, I nearly forgot the Plavix medication (clopidogrel). First guidelines said minimum 1 year, then 2 years and now in the UK they say minimum 3 with possibility of life. My first stent in 2007 is still fully open with no sign of disease and I stopped clopi after 18 months. I think it depends on the individual. I would stay on them for 2 years min to be sure but you have to consider the odds after that carefully because they can cause internal bleeding with some people. So after a couple of years your cardiologist has an impossible job of deciding if you have a greater chance of bleeding to death internally, or having a stroke/heart attack. However, I think in 2 years there will be a much better understanding of what is going on.

Your pains are common after stenting. I had chest pains for quite a few weeks. In september last year I had 5 stents put into my left artery which caused pinching sensations for a month. I found bisoprolol caused a few discomforts in the chest, it was brilliant to feel the difference when I stopped the drug. To feel your heart run free is strange at first, it feels like its going to pop out of your chest, but you soon get used to it.

Take care.

[uwalty]

Thanks Guddoohira and ed34.
The response you sent is quiet helpful and does make me feel bit better and more comfortable.
Its not all good when you have just come off from this problem and there is so much negativity on internet that it made me feels worst at times. But this forum has been a good help and i am expecting more responses from people who had similiar problems.
My good wishes to both of you for healthy life ahead. Keep in touch

[Cleveland Clinic]

To answer your questions:
1. Is there a damage done to my heart? Yes, because the troponin was significantly elevated. But your ejection fraction is normal, which has a better prognosis than if it was diminished.
2. Can these 30% blocks be a problem for me. YEs, it is these 30% blockages that rupture and cause new heart attacks. You need to be on aspirin, plavix and  lipitor.
3. Do i need to continue on all the 5 tablets i have being prescribed for rest of my life? ( Aspirin, Atrovastatin, Clopidgrel, Bisoprolol, Ramipril). Yes.
4. Ejection fraction - is this normal range and will i have a normal ECG in future. No, in some patients the q waves will remain.
5. The recovery time is said to be from 3 - 6 months. What does this mean to me? And will it make me more stronger after that period. I get occasional pains locally in my chest( nothing like heart attack pain), in legs - and i assume it is just a muscle pain. Can this 30% blocks result in such a pain? Not likely related to the small blockages, more likely pericarditis post myocardial infarction, which is pain in the lining of the heart resultant from inflammation.

[uwalty]

Thanks for your responses so far. I did my blood test recently after 6 weeks of MI and the results are good i guess. The Cholestrol level has come down from 210 to 100 ( around 5.4 to 2.3); LDL from 170 to 45( 4.11 to 1.8); HDL from 36 to 28 (.9 to .6).
I hope if i mantain this levels i would be able to be safe.
There are lots of things i read and one thing that distrubs me is the rhestonisis - reversal of blockage on the stent. Can i avoid it if i maintain my levels and take medications. I don't want this problem to come in my life again and though difficult want to forget this MI issue in my life.