Heart attack and TIA in the same week

[jenstu10]

My mother is 59, thin, healthy woman.  Recently she suffered a TIA on a Monday night.  They performed a CT, MRI, and ran a coagulopathy workup to test for any clotting disorders.  Everything came back negative.  They put her on Plavix and 325 mg aspirin and sent her home the next day.  The very same week, Friday morning, she suffered a heart attack.  Thankfully, she went to the doctor and they were able to treat her before too much damage was done.  She had a long 80-90% blockage of her right coronary artery.  They put in two drug-releasing stents and she’s now on Plavix, aspirin (81mg), an anti-cholesterol med, and a beta-blocker.  They ran all kinds of tests:  checked homocysteine levels, did a transesophageal echo to rule out a patent foramen ovale, etc.  The only thing they found was a mitral valve prolapse, but I’m not sure what the severity was.

My question is:  do you have any other ideas as to what could explain these two episodes that occurred within a few days of each other to a woman who is relatively risk-free?  Are there any other tests you would recommend be performed?

[CCF-M.D.-MJM]

Hello,

Sorry to hear about your mother. That is a lot to got through in one week.

1. Do you have any other ideas as to what could explain these two episodes that occurred within a few days of each other to a woman who is relatively risk-free?  

That is the same work up that we would have done here.  It is possible that she was pretty stressed because of the TIA and this caused increased demandon her heart in a sort of "stress test" that declared her underlying coronary disease.  You will never know for sure.  The biggest thing to worry about is the PFO which it sounds like they already ruled out.  Now the main issue is risk reduction for further events with the right life style and medications.

2. Are there any other tests you would recommend be performed?

It depends on how she feels and it is difficult to get a sense of that on this forum.  For now it sounds like she has had the right tests.  Just make sure you have a good relationship with your doctor and that you trust them.

I you and your family a speedy recovery.  Thanks for posting.

[Healthyself2]

Perhaps the TIA diagnosis was wrong.  Perhaps the episodes where really near syncope.  

For that matter the heart attack diagnosis could be wrong also.  A 80-90% restriction of the RCA might not be a big deal or really an emergency situation.  Agressive cholesterol therapy over 3-5 years could probably improve that and minimize risk.  Unfortunately when you present like that they are probably going to try to fix you with their standard toolkit first.

Anyway it sounds like your mom has been through the mill.  If she continues to have the "TIA" episodes you might want to explore further if they are really that.

Of course now that there are stents in place, Plavix is an indicated drug, but it's not without risk - it's not really the super aspirin that it is marketed on TV to be.  The beta blocker may increase the symptoms if the TIA was misdiagnosed.

I know of a defensive coach in the NBA who was wrongly diagnosed as having "TIA" episodes last season and got sidelined in his career.

If this continues, I suggest starting with a clean sheet of paper.  Belief systems can be deadly.

Good Luck

[Flycaster305]

Do I agree with you!  I was one of those who rejected the cholesterol-controlling drugs seven years ago, choosing a more 'natural' approach.  My total cholesterol reading was about 380, I quit eating beef and pork, ate skinned chicken occasionally, ate fish, the good oils, lots of vegetables, etc and lost a lot of weight.  I got my cholesterol level down to about 220, raised my HDL by exercising an hour a day, and thought I had it knocked.  Three heart attacks, some stents, and a diagnosis of CFH sort of gave me a medical wedgie!  I have since read that a very aggressive dietary approach can reduce the cholesterol no more than 1/3.  I've come to the conclusion that it is smart to follow the medical research.  Watching the screen during an angiogram is quite a wakeup call.  Your comment is right on the money!