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Heart Disease (Expert Forum)
Full Metal Jacket
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
Full Metal Jacket
by melisa-__0, Dec 25, 1998 12:00AM
Per an MSNBC report online Dr. Eric Topol of the Cleveland Clinic suggests that stents are being used to often. I had a spontaneous coronary atery dissection 2 1/2 months ago as i have previously reported to you. The doctor placed 5 stents in the RCA, at the time of my dissection and said everything would be ok not to worry. Well, Tuesday the 22nd i had to go back in and have an 8mm stent added between No. 1 and No. 2 because i had a 70 percent narrowing in that area, so I now have 6 stents in my RCA. Is, this the best course of action, or is my doctor using too many stents? I am concerned about the number of stents i now have, based upon Dr. Eric Topols report. What ar e my future risks and concerns , now that I am referred to as having a full metal jacket in my RCA? Should i maybe be a bypass candidate or will the stents be a long term and permanent treatment for spontaneous RCA dissection?
Also, I am having some wierd temperature fluctuations occuring, as I sit here writing this, my left hand is warm(above or at room temperature), but my right hand is very cold, is this something I should be concerned about? And have you ever heard of this in heart patients?
Sorry so long this time but I am just very concerned and afraid.
Thanks for your time and your response.
Doctor's Answer
by CCF Cardio MD - MTR, Dec 25, 1998 12:00AM
_
Dear Melissa, thank you for your question. Your situation is rather unique, so it's hard to generalize about the overuse of stents in your case. A spontaneous coronary artery dissection is a rare condition that has to be treated aggressively or the coronary artery will permanently close. In a dissection, the inner lining of the blood vessel called the intima tears and blood dissects down the entire course of the vessel. This will disrupt and often stop blood flow to the distal coronary artery where nutrients and oxygen are delivered to the heart muscle. To maintain blood flow to your distal right coronary artery, your cardiologists had to place multiple stents to "seal" the dissection flap so that normal blood flow was restored. Traditional balloon angioplasty would not work in this situation. The main risk that you have with stents is renarrowing within the stents - termed restenosis. It sounds like you've already had restenosis between two stents, so another stent was appropriately placed. Normally, restenosis occurs within 6 months, so if you get past 6 months without restenosis, then your stents should remain patent for quite some time thereafter. If restenosis does occur within the stents, there are treatments that can be given, but you would have to discuss those with your own cardiologist. Likewise, I can't answer the question about whether you are a candidate for bypass surgery. Finally, I don't know what could be causing the temperature differential between your hands, but I doubt it's related to your heart.
I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions. Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart
Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
Dear Melissa, thank you for your question. Your situation is rather unique, so it's hard to generalize about the overuse of stents in your case. A spontaneous coronary artery dissection is a rare condition that has to be treated aggressively or the coronary artery will permanently close. In a dissection, the inner lining of the blood vessel called the intima tears and blood dissects down the entire course of the vessel. This will disrupt and often stop blood flow to the distal coronary artery where nutrients and oxygen are delivered to the heart muscle. To maintain blood flow to your distal right coronary artery, your cardiologists had to place multiple stents to "seal" the dissection flap so that normal blood flow was restored. Traditional balloon angioplasty would not work in this situation. The main risk that you have with stents is renarrowing within the stents - termed restenosis. It sounds like you've already had restenosis between two stents, so another stent was appropriately placed. Normally, restenosis occurs within 6 months, so if you get past 6 months without restenosis, then your stents should remain patent for quite some time thereafter. If restenosis does occur within the stents, there are treatments that can be given, but you would have to discuss those with your own cardiologist. Likewise, I can't answer the question about whether you are a candidate for bypass surgery. Finally, I don't know what could be causing the temperature differential between your hands, but I doubt it's related to your heart.
I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions. Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart
Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
