MI, RCA 100%, Collateral flow = Angioplasty !

[ggoran]

Hi,

I'm 40yo, had MI 40 days ago, cath showed 100% occlusion of RCA
at RV with colateral flow from left arteries to blocked area.
-LEFT VENTRICAL - SYS: 120 LVEDP:31
-AORTA          - SYS: 124 DIAST:67 MEAN: 90
They say it was minor MI ( no big damage to heart ), I passed  echo-cardiogram, and treadmill stress test.
They want to do angioplasty.
I'm not so sure about it - what risk I'm taking if I do not choose angioplasty and try to leave with the blockage ?
( stop smoking, start excersising, control lipids, loose weight  and stick to the meds )
I feel only mild angina if at all ( sometimes I have feeling that its related to my stomach upset or my hipersensitivity to any feeling in the chest ).
Whould some test help more to determine if blocked area is receiving enough blood ? Over time is it possible to build stronger collaterals to increase blood flow to blocked area ?
Thank you in advance for the reply, and this great service !!!
Goran ( GL to everybody )

[CCF-M.D.-KE]

Dear Ggoran,

Sorry to hear about your recent MI. You have described experiencing a recent MI with a totally occluded RCA and I presume no other significant blockages. You pose a very interesting and controversial question that I enjoyed researching.  

In the past chronic total occlusions(CTO) were felt to be a contraindication for angioplasty. However, with the advancement of technology and new research the success rate of angioplasty in CTO is approximately 70%. Treatment of CTO has been shown to improve symptoms, pumping function of heart and to reduce the need for bypass surgery. There is also an improvement in survival associated with successful treatment of a chronic total occlusion compared to those treated with just medication. Predictors of poor outcome include calcification at the site of the blockage, blockages in multiple vessels, and a blockage greater than 2cm in length. However, there are some risks. Some large studies have shown that the risk of another MI and emergency bypass surgery is around 1%. There is also a risk of renarrowing of the artery(without stent placement) reported around 39% in one study. This renarrowing may be even lower if stents are placed.

I think it is reasonble to consider angioplasty (?stent placement)  in your case. I would recommend discussing your concerns at length with your doctors until all of your questions are answered.

Thanks for your question,


CCF-MD-KE

[HealThySelf]

I was waiting for the doctor to answer, before I commented, but it's been a couple of days since you posted.

You're situation sounds similar to mine.  Three years ago, at age 50, I had a minor heart attack the morning after hiking at 10,000 feet elevation.

During a subsequent angiogram, it was discovered that my RCA was 100% occluded.  They tried to do angioplasty, but couldn't pass a wire through the occlusion.

My cardiologist said the blockage was longstanding, as much as 15 years old.  It was moderately collateralized.  I decided that if I had lived with it that long, I could continue to live with it and decided against bypass surgery.

I opted for pharmacological lipid and bp therapy, daily exercise, lower fat diet, vitamins and supplements, and lifestyle changes.

A year and a half later, I agreed to another attempt to open it with an experimental device designed to open total occlusions.  I had high hopes, but the procedure only lasted 10 minutes when it was discovered that I had a large "cratered" plaque in my left main.  They said it was too dangerous to proceed and pushed me hard for bypass surgery telling me that I had a 40% chance of sudden death within 5 years.

After that I gave up on having that RCA opened.  I really don't know that it's important, seeing that my collaterals had developed much more over the year and a half between angiograms, and I now have a pretty normal flow to the bottom of that artery. I plan no further angiograms, angioplasty attempts, or bypass surgery, unless I lose my physical ability.

I have continued refining my aggressive lipid therapy and my program of exercise.  I brought my total cholesterol down from 240 to 110 thanks to a combination of drugs.

Yesterday I hiked up to a mountain lake in the North Cascades that was an 8 mile round trip and a 4,000' foot elevation gain.  That's about my current limit for sustained exersion.

My test for whether I am doing alright is:

1.  Do I feel good?
2.  Can I physcially do the things that I want to do?

If the answer is yes to both of these, I take my meds and go to the doctor once a year, and go about leading a normal life.

I have used aggressive lipid therapy coupled with strenuous long duration low intensity aerobic exercise to hold the line with my disease.  In my case, I take 2 to 3 months off every year and just hike in the mountains and have fun.  When I am working, I walk a hilly circuit 30 minutes before work and 30 minutes before lunch every day, and do things more stenuous on the weekends.

Also smoking = death.  Don't bother with any of the other stuff if you continue smoking.  I had a good friend that had bypass surgery and continued to smoke.  He dropped dead a year later.

The occluded RCA doesn't pose much danger to you.  A certain amount of heart muscle beyond it is already dead and a new blood supply probably won't help it much.  The important thing is to halt the progression of the other plaques that are forming in more critical arteries like the left main and LDA.

Best of luck to you.

[ggoran]

Thank you very much for describing your "case".

It is very important for me to learn how other people cope/fight with this nasty deasese.

I would like to get more chance to speak to you about our conditions, so if you don't mind please contact me at ***@****.

I have only one thing to answer to myself before maing decision for/against angio - what are sensations that I'm feeling in the chest - is it angina or not ? However time is running out - I'm scheduled for Oct 25 :-)

Thanks,
Goran

[ggoran]

Thank yo very much for you answer.

It helps, however I was more looking to find out what are risks if I do not undergo angioplasty:

could it lead to weak heart, arithmias or other complications ?

Thanks again
Goran