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My father just had a massive heart attack, what did the doctors mean?
My father had a massive heart attack yesterday, followed by another heart attack in the hospital. From what the doctors say he's very luck to be alive. Supposidly, his heart was having problems for over a week yet my dad didn't feel anything. We found out today that more than 50% of his heart was damaged and he may need bypass surgery. It's so soon after that I wonder if my dad is going to be OK especially with that much of his heart damaged. Can someone please tell me what I can expect in the next few days? Basically, since he survived the heart attack does that mean he will make it home.
I stay with the proposition that the specialist will recommend his/her specialty all to often with the exclusion of other therapies that may be appropriate, and not meant to 100% accurate. I am saying there are competing interests among specialists based on one's training, interests and experience...financial self interst aside. The point of my post was to ALWAYS get a second opinion before any intervention i.e. stent implant and CABG and why. There are numerous readings on the subject, and I submit the following as an example non edited:
Health News Feature
Weekly news feature articles on current health topics that affect you and your family.
How well does angioplasty work?
The experts differ over procedure’s merits in many cases
(HealthDay News) -- Heart specialists perform an estimated 1.2 million angioplasty procedures each year, according to the Society for Cardiovascular Angiography and Interventions. But are they all necessary?
That depends on whom you ask, and what studies you cite.
Conventional cardiology wisdom has long held that heart attacks occur because arteries blocked by the buildup of plaque starve the organ of blood, sending it into a condition called infarction. Under that model, angioplasty, stenting (placing of a wire mesh structure in the blood vessel) and bypass surgery all make a certain amount of sense.
The technology allows doctors to thread a snake-like device with a balloon on the end into diseased and narrowed arteries. Inflating the balloon widens the blockage. Usually, cardiologists will leave behind one or more tiny metal scaffolds, called stents, as insurance.
Many cardiologists have long held that heart attacks result not solely from severe narrowing but also from so-called "vulnerable" plaques that shear off vessel walls, leading to clotting and infarction. That view has been gaining increasing credence lately, even among more aggressive heart doctors -- with major implications for invasive procedures to widen vessels.
While it's true that a very tight blockage causing chest pain -- or angina -- may spark a heart attack, most attack occur at narrow spots in the blood vessel that are less serious but are considered to be vulnerable to plaque rupture. (my insertion, vulerable plague is not seen with angioplasy...a ct scan 64 slice reveals vulnerable plague and the risk of future heart attack).
AS A RESULT, EXPERTS SAY, MANY PEOPLE WHO UNDERGO ANGIOPLASTY AND STENTING WOULD LIKELY DO FINE WITH THE SO-CALLED 'VASCUL0-PROTECTIVE COCKTAIL" THAT ADDRESS VESSEL DISEASE AND ITS COMPLICATIONS: statins for cholesterol, aspirin to prevent clotting, ACE inhibitors to improve heart function, beta-blockers for blood pressure, relaxing vessels and correcting abnormal heart rhythms.
But changing practice patterns might take some time, said Dr. Jonathan Abrams, a cardiologist at the University of New Mexico School of Medicine, in Albuquerque. "It's too big a boat to turn, it hasn't turned yet," Abrams said. "THERE CLEARLY ARE PEOPLE WHO NEED ANGIOPLASTY. THE ISSUE IS HOW TO USE THERAPIES AND WHO TO USE THE IN.'
Dr. Thomas Graboys, of the Lown Cardiovascular Center, and Harvard Medical School, in Boston, provides second opinions to patients who've been told they need angioplasty.
Although exact numbers are elusive, Graboys estimates that half of Americans who receive stents each year could do just as well on medical therapy. "We're not against stents, they can be potentially lifesaving," Graboys said. "But that's not the population that's receiving them. Medical therapy is very good, it's outstanding now," he added. "Compared to 10 years ago we've turned the corner in management" of coronary artery disease.
The most important question cardiologists should ask, Graboys said, is not how narrow their patients' arteries are but how well their heart works. "If it's strong, they do well despite vessel blockage. But that's not what's happening in this country."
To be sure, Graboys said, many patients are good candidates for angioplasty and stenting -- just not as many as undergo the procedures. If a person has persistent chest pain -- called unstable angina -- that doesn't improve with medication, then he'd advise more aggressive treatment.
In addition to being unnecessary in many cases, stenting isn't risk-free. Around 1 percent of patients suffer a blood clot linked to the stent procedure itself. (I BELIEVE THAT STATISTIC HAS INCREASED WITH DES). Of those, 10 percent to 20 percent prove fatal. That means 1 to 2 of every 1,000 stent recipients dies as a direct result of the device. If Graboys and like-minded doctors are correct, that works out to between 600 and 1,200 unnecessary deaths each year.
Nor is stenting always successful in the vast majority of patients who survive the procedure. Blood vessels close up around the devices, a phenomenon called restenosis, in about 20 percent of patients. (DES MAY BE HIGHER THAN BARE METAL FOR THE FIRST YEAR AFTER IMPLANT)
So why is angioplasty overused? The answer is largely economic, Graboys said. Angioplasty costs roughly $15,000. Conventional stents run around $2,000 each, but new, drug-releasing stents that promise less restenosis cost about twice that much. "The market forces are incredible," he said, with "a host of non-clinical factors" driving the use of the technology.
Cardiologists, Abrams agrees, are generally overeager when it comes to angioplasty. "We're doing too much ballooning, and now that we have stents it's even worse," he said.
Abrams is an advocate of much wider use of the vasculo-protective drug regimen. "That cocktail clearly reduces risk and may in fact stop atherosclerosis in its tracks," he said. Doctors need to work toward ensuring that every patient discharged from the hospital with coronary artery disease leaves with a prescription for the treatment--regardless of whether or not they've had angioplasty, he said. "This is the place to put our money, and we are not doing an adequate job." (My non-interventional cardiologist takes the same position and I have been successfully treated with medication goping on 5 years).
More information
The National Institutes of Health’s Web site has a good discussion on the pros and cons of angioplasty.
SOURCES: Interviews with Jonathan Abrams, M.D., cardiologist,e University of New Mexico School of Medicine, Albuquerque;
Thomas Graboys, the Lown Cardiovascular Center, and Harvard Medical School, Cambridge, Mass.; National Institute’s of Health U.S. National Library of Medicine
Publication Date: May 31, 2004
Author: Adam Marcus, HealthDay Reporter
Copyright © 2004 ScoutNews, LLC. All rights reserved
Health News Feature
Weekly news feature articles on current health topics that affect you and your family.
How well does angioplasty work?
The experts differ over procedure’s merits in many cases
(HealthDay News) -- Heart specialists perform an estimated 1.2 million angioplasty procedures each year, according to the Society for Cardiovascular Angiography and Interventions. But are they all necessary?
That depends on whom you ask, and what studies you cite.
Conventional cardiology wisdom has long held that heart attacks occur because arteries blocked by the buildup of plaque starve the organ of blood, sending it into a condition called infarction. Under that model, angioplasty, stenting (placing of a wire mesh structure in the blood vessel) and bypass surgery all make a certain amount of sense.
The technology allows doctors to thread a snake-like device with a balloon on the end into diseased and narrowed arteries. Inflating the balloon widens the blockage. Usually, cardiologists will leave behind one or more tiny metal scaffolds, called stents, as insurance.
Many cardiologists have long held that heart attacks result not solely from severe narrowing but also from so-called "vulnerable" plaques that shear off vessel walls, leading to clotting and infarction. That view has been gaining increasing credence lately, even among more aggressive heart doctors -- with major implications for invasive procedures to widen vessels.
While it's true that a very tight blockage causing chest pain -- or angina -- may spark a heart attack, most attack occur at narrow spots in the blood vessel that are less serious but are considered to be vulnerable to plaque rupture. (my insertion, vulerable plague is not seen with angioplasy...a ct scan 64 slice reveals vulnerable plague and the risk of future heart attack).
AS A RESULT, EXPERTS SAY, MANY PEOPLE WHO UNDERGO ANGIOPLASTY AND STENTING WOULD LIKELY DO FINE WITH THE SO-CALLED 'VASCUL0-PROTECTIVE COCKTAIL" THAT ADDRESS VESSEL DISEASE AND ITS COMPLICATIONS: statins for cholesterol, aspirin to prevent clotting, ACE inhibitors to improve heart function, beta-blockers for blood pressure, relaxing vessels and correcting abnormal heart rhythms.
But changing practice patterns might take some time, said Dr. Jonathan Abrams, a cardiologist at the University of New Mexico School of Medicine, in Albuquerque. "It's too big a boat to turn, it hasn't turned yet," Abrams said. "THERE CLEARLY ARE PEOPLE WHO NEED ANGIOPLASTY. THE ISSUE IS HOW TO USE THERAPIES AND WHO TO USE THE IN.'
Dr. Thomas Graboys, of the Lown Cardiovascular Center, and Harvard Medical School, in Boston, provides second opinions to patients who've been told they need angioplasty.
Although exact numbers are elusive, Graboys estimates that half of Americans who receive stents each year could do just as well on medical therapy. "We're not against stents, they can be potentially lifesaving," Graboys said. "But that's not the population that's receiving them. Medical therapy is very good, it's outstanding now," he added. "Compared to 10 years ago we've turned the corner in management" of coronary artery disease.
The most important question cardiologists should ask, Graboys said, is not how narrow their patients' arteries are but how well their heart works. "If it's strong, they do well despite vessel blockage. But that's not what's happening in this country."
To be sure, Graboys said, many patients are good candidates for angioplasty and stenting -- just not as many as undergo the procedures. If a person has persistent chest pain -- called unstable angina -- that doesn't improve with medication, then he'd advise more aggressive treatment.
In addition to being unnecessary in many cases, stenting isn't risk-free. Around 1 percent of patients suffer a blood clot linked to the stent procedure itself. (I BELIEVE THAT STATISTIC HAS INCREASED WITH DES). Of those, 10 percent to 20 percent prove fatal. That means 1 to 2 of every 1,000 stent recipients dies as a direct result of the device. If Graboys and like-minded doctors are correct, that works out to between 600 and 1,200 unnecessary deaths each year.
Nor is stenting always successful in the vast majority of patients who survive the procedure. Blood vessels close up around the devices, a phenomenon called restenosis, in about 20 percent of patients. (DES MAY BE HIGHER THAN BARE METAL FOR THE FIRST YEAR AFTER IMPLANT)
So why is angioplasty overused? The answer is largely economic, Graboys said. Angioplasty costs roughly $15,000. Conventional stents run around $2,000 each, but new, drug-releasing stents that promise less restenosis cost about twice that much. "The market forces are incredible," he said, with "a host of non-clinical factors" driving the use of the technology.
Cardiologists, Abrams agrees, are generally overeager when it comes to angioplasty. "We're doing too much ballooning, and now that we have stents it's even worse," he said.
Abrams is an advocate of much wider use of the vasculo-protective drug regimen. "That cocktail clearly reduces risk and may in fact stop atherosclerosis in its tracks," he said. Doctors need to work toward ensuring that every patient discharged from the hospital with coronary artery disease leaves with a prescription for the treatment--regardless of whether or not they've had angioplasty, he said. "This is the place to put our money, and we are not doing an adequate job." (My non-interventional cardiologist takes the same position and I have been successfully treated with medication goping on 5 years).
More information
The National Institutes of Health’s Web site has a good discussion on the pros and cons of angioplasty.
SOURCES: Interviews with Jonathan Abrams, M.D., cardiologist,e University of New Mexico School of Medicine, Albuquerque;
Thomas Graboys, the Lown Cardiovascular Center, and Harvard Medical School, Cambridge, Mass.; National Institute’s of Health U.S. National Library of Medicine
Publication Date: May 31, 2004
Author: Adam Marcus, HealthDay Reporter
Copyright © 2004 ScoutNews, LLC. All rights reserved
The above statement "A surgeon will say a bypass is necessary, and interventional cardiologist will say an angioplasty and stent and the non-interventional cardiologist will suggest medicatrion and possibly EECP." is not always accurate.
While each has their specialty and wants to perform their specialty, the procedure selected should be dictated by the problem.
I had a triple bypass several years ago that was necessary due to the location and extent of the blockages. I was not a candidate for angioplasty and medication would have only made me comfortable for my final hours (as one doctor recommended). My only symptoms were nausea. Apparently I had been slowly choking off the blood supply to my heart. They installed a balloon pump to assist my heart and it recovered enough for them to do the bypass. Yes, I had and still have damage to the heart muscle but increasing the blood flow with the bypass and going through the rehab has really made a difference. My heart had actually recovered quite a bit. Sorry, I don't know the extent of my damage before and after, but my Ejection Fraction (measure of how much the heart pumps) went from 12% (before) to 62% at the last test.
Also, there are tests that can be performed to determine the extent of the damage to the heart muscle. They can tell which parts of the muscle are getting oxygen and which are not.
I'm not a Dr, but I think he has a couple of things going for him at this point - he survived the previous attacks and he has the Dr's (and the rest of the staff) watching him, and his test results, closely. I wouldn't be surprised to hear he has a bypass or some stents in his near future.
Best of luck!
While each has their specialty and wants to perform their specialty, the procedure selected should be dictated by the problem.
I had a triple bypass several years ago that was necessary due to the location and extent of the blockages. I was not a candidate for angioplasty and medication would have only made me comfortable for my final hours (as one doctor recommended). My only symptoms were nausea. Apparently I had been slowly choking off the blood supply to my heart. They installed a balloon pump to assist my heart and it recovered enough for them to do the bypass. Yes, I had and still have damage to the heart muscle but increasing the blood flow with the bypass and going through the rehab has really made a difference. My heart had actually recovered quite a bit. Sorry, I don't know the extent of my damage before and after, but my Ejection Fraction (measure of how much the heart pumps) went from 12% (before) to 62% at the last test.
Also, there are tests that can be performed to determine the extent of the damage to the heart muscle. They can tell which parts of the muscle are getting oxygen and which are not.
I'm not a Dr, but I think he has a couple of things going for him at this point - he survived the previous attacks and he has the Dr's (and the rest of the staff) watching him, and his test results, closely. I wouldn't be surprised to hear he has a bypass or some stents in his near future.
Best of luck!
QUOTE: "My father had a massive heart attack yesterday, followed by another heart attack in the hospital. From what the doctors say he's very luck to be alive. Supposidly, his heart was having problems for over a week yet my dad didn't feel anything. We found out today that more than 50% of his heart was damaged and he may need bypass surgery. It's so soon after that I wonder if my dad is going to be OK especially with that much of his heart damaged. Can someone please tell me what I can expect in the next few days? Basically, since he survived the heart attack does that mean he will make it home. "
To state a percentage of heart muscle damage is an exercise in non-medical gibberish.
A measurement of heart damage is based on the percentage of blood pumped with each stroke...normal is 55 to 75% and below 30% is considered heart failure as it is assumed the % below 30% is not enough blood/oxygen to meet the system's needs.
Several years ago, I had a silent heart attack (no symptoms) but my heart failed to adequately pump adequately and blood from the lungs to be pumped out backed up into the lungs causing congestion (pulmonary edema) ...congested heart failure. There appeared to be heart muscle damage as contractions were weak and that condition causes a low EF. I had an enlarged left ventricle, totally blocked LAD, 72% blockage of ICX and a 98% RCA blockage that was stented. The :LAD had developed a natural bypass and RCA was stented to provide more blood to the deficit area from LAD blockage, etc. I was in ICU for about 3 days. Currently, the damaged heart cells are now functioning normally and EF is 59%. I mention this to inform you that sometimes damaged cells can be rejuvenated if treatment is timely.
If there are multiple blockages, surgery may be the only option, but if there is a single vessel blockage a stent may be appropriate. If pain can be controlled with medication, there may be no need for intervention (stent or CABG). You can google COURAGE STUDY that compares the options available for ischemia (lack of blood flow) and the results show there is very little difference for longivity. A by-pass may be necessary if the blockage is too long for a stent, the location can't be stented, etc.
A surgeon will say a bypass is necessary, and interventional cardiologist will say an angioplasty and stent and the non-interventional cardiologist will suggest medicatrion and possibly EECP.
To state a percentage of heart muscle damage is an exercise in non-medical gibberish.
A measurement of heart damage is based on the percentage of blood pumped with each stroke...normal is 55 to 75% and below 30% is considered heart failure as it is assumed the % below 30% is not enough blood/oxygen to meet the system's needs.
Several years ago, I had a silent heart attack (no symptoms) but my heart failed to adequately pump adequately and blood from the lungs to be pumped out backed up into the lungs causing congestion (pulmonary edema) ...congested heart failure. There appeared to be heart muscle damage as contractions were weak and that condition causes a low EF. I had an enlarged left ventricle, totally blocked LAD, 72% blockage of ICX and a 98% RCA blockage that was stented. The :LAD had developed a natural bypass and RCA was stented to provide more blood to the deficit area from LAD blockage, etc. I was in ICU for about 3 days. Currently, the damaged heart cells are now functioning normally and EF is 59%. I mention this to inform you that sometimes damaged cells can be rejuvenated if treatment is timely.
If there are multiple blockages, surgery may be the only option, but if there is a single vessel blockage a stent may be appropriate. If pain can be controlled with medication, there may be no need for intervention (stent or CABG). You can google COURAGE STUDY that compares the options available for ischemia (lack of blood flow) and the results show there is very little difference for longivity. A by-pass may be necessary if the blockage is too long for a stent, the location can't be stented, etc.
A surgeon will say a bypass is necessary, and interventional cardiologist will say an angioplasty and stent and the non-interventional cardiologist will suggest medicatrion and possibly EECP.
hey there,
I took my dad to the doctor a year ago. the doctor was screaming at me the whole time, asking me what is the reason that my dad ( who had 2 or 3 heart attacks by then) did not go under the bypass surgery!?
I really didn't have any idea of what is going on with him as my older brother was supposedly taking care of him. so a year went by and about 2 weeks ago, he fell on the floor, screaming from pain and complaining about breathing problem. we called 911 and they took him to the hospital for a triple bypass right away.
when they tell you that he had a heart attack it means that 1 or 2 or maybe more of his blood vessels are clogged for the verity of reasons. it really is your choice to have the operation now or just wait till he falls on the floor like my dad.
the heart itself is just a big mussel and except in rare occasions nothing is happening to this mussel itself. But the blood vessels get clogged because of hundreds of reasons and believe it or not every year, only in the U.S, more than 500,000 people go under the same operation.
Please take your dad to a doctor and ask them to run the necessary tests even if he is not willing to go with you. Good luck!
I took my dad to the doctor a year ago. the doctor was screaming at me the whole time, asking me what is the reason that my dad ( who had 2 or 3 heart attacks by then) did not go under the bypass surgery!?
I really didn't have any idea of what is going on with him as my older brother was supposedly taking care of him. so a year went by and about 2 weeks ago, he fell on the floor, screaming from pain and complaining about breathing problem. we called 911 and they took him to the hospital for a triple bypass right away.
when they tell you that he had a heart attack it means that 1 or 2 or maybe more of his blood vessels are clogged for the verity of reasons. it really is your choice to have the operation now or just wait till he falls on the floor like my dad.
the heart itself is just a big mussel and except in rare occasions nothing is happening to this mussel itself. But the blood vessels get clogged because of hundreds of reasons and believe it or not every year, only in the U.S, more than 500,000 people go under the same operation.
Please take your dad to a doctor and ask them to run the necessary tests even if he is not willing to go with you. Good luck!
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