Out of breath after Heart Stents

[Flycaster305]

64 years old, 6' 2", 210 pounds, retired, work out daily at a gym.  History of high cholesterol.  I had a heart attack five years ago.  A recent stress test concluded I needed an Angiogram, which lead to two stents installed.  The Operative report included:  
1.  Unremarkable left main.
2.  Anterior descending demonstrating two areas of excentric plaque treated with 4 x 12 and 2.5 x 8 stents, with excellent results.  This is the area of ischemia on his receont isotope stress.
3.  Circumflex free of disease.
4.  Dominant right coronary demonstrates multiple areas of non-critical stenosis with intercurrent thrombus.  This area was not approached at this time.  Inferior wall demonstated scar with no reversibility on his recent isotope stress.
5.  Left ventricular ejection fraction 48% with some inferior wall hypokinesis.  Left ventricular end diastolic pressure of 38 pre-, 30 post-left ventiriculogram.
I am taking Plavix, Coreg, Aspirin and Vytorin.  My questions:
l.  Since the stents were installed two months ago, I run out of breath and tire rather quickly when exercising or climbing stairs.  Does the stenting procedure itself require a healing period, during which time the heart isn't working as well as it could?
2. I'm curious what the left ventricular end diastolic pressure readings indicate.
3. I am having severe muscle spasms in my back, particularly at night, and haven't done anything to aggravate the muscles.  I read that Vytorin can cause muscle soreness, but could it also cause muscle cramping?  Thank you for this forum.

[CCF-M.D.-MJM]

Hello flycaster,

Sorry to hear about your symptoms.

l. Since the stents were installed two months ago, I run out of breath and tire rather quickly when exercising or climbing stairs. Does the stenting procedure itself require a healing period, during which time the heart isn't working as well as it could?

In general the recover period for a stenting not associated with an acute infarct is just a few days, more related to the arterial access site than heart remodeling.  In certain circumstances where the tissue beyond the blockage was not getting enough blood at rest and was compromised, this may take some time to recover.  People don't usually feel worse than prior to the stent.

2. I'm curious what the left ventricular end diastolic pressure readings indicate.

LVEDP (LV end diastolic pressure) is a direct measure of hte fillig pressure in your heart. In your case, LVEDP in the 30's suggusts increased pressure and is more than likely the reason for your symptoms.  Interpretatio of this reading depends on clinical circumstances as to whether it is predominatly secondary to  systolic or diastolic causes, althoug sometimes it is both.  Often this helped with a diuretic, although this assume you are on appropriate medical therapy which in your case likely includes a beta blocker, ACE inhibitor, aspirin, palvix and a statin.  I see that you are on all of these buy an ACE inhibitor and a diuretic.  Your doctor may have a good reason, but it is always reasonable to ask.

3. I am having severe muscle spasms in my back, particularly at night, and haven't done anything to aggravate the muscles. I read that Vytorin can cause muscle soreness, but could it also cause muscle cramping?

Good question, often misunderstood.  It applies to muscle soreness, not cramping.

I hope this helps.  Good luck and thanks for posting.

[CCF-M.D.-MJM]

hydrochlorothiazide is a good diuretic for high blood pressure, it is not as good at removing excess water.  For that, a different class of diuretic is used -- a loop diuretic, like lasix of furosemide.

to the same note, furosemide is good for taking off excess water (or in your case, decreasing LVEDP), but not as good for hypertension.

[Flycaster305]

Thank you, that was very helpful.  I forgot to mention I'm taking Hydrochlorothiazide as well.

[MLWTR]

In that case, you are taking a diuretic, because that's what hydrochlorothiazide is.

[SCnurse]

My Dad is 56 years old and decided about 2-3 years ago to begin seeing a cardiologist due to his strong family history of coronary artery disease. Fourteen months ago he had his first stress test and his doctor told him at that time it was unremarkable. A few months back, he began feeling something "strange" and "different" in his chest, but denied any chest pain. Well, it was time for his yearly cardiologist visit, so when he went to his doctor and had another nuclear stress test performed. Dr. A told my Dad that the test picked up a "70% blockage in a vessel in the bottom of his heart" and he wanted my Dad to be cathed. So, he scheduled Dad for a heart cath for two weeks later. (Isn't that a LONG TIME to wait, first of all?) In the meantime, he started him on Toprol XL to be taken at night. (Does this sound right?) Within this two weeks that he waited for his cath, he reported one 5-second episode of definite chest pain while at work pointing to a calendar that quickly went away. Okay, fast forward to his heart cath last Monday. This was an extremely emotional day for me, my Mom, and my sister. I've been a critical care nurse for a couple of years now. I knew in the back of my mind that a strong family history of CAD and years of smoking on and off, plus only a little regard to diet would eventually catch up to him (and all of us), but I didn't think this soon. Dad is not overweight, always been active, and takes his lipitor religiously. Dr. A came out and reported to us that Dad did have a 70-75% occlusion in his RCA which he stented with a drug-eluting stent. That was the "good" news. In addition, to his RCA, he had 3 other 30-40% occlusions which he did not intervene with. In Dr. A's words, "We will watch those carefully and treat them with meds and your Dad must do the rest with lifestyle change." (Which Dad has already done a complete turnaround!) He went on to say, "They may be reversed with meds, diet, exercise, and not smoking." Now I have NEVER heard of occlusions reversing. Does this sound right? So, he was started on plavix and altace in addition to his meds he already takes: aspirin, lipitor, torprol xl, and multivitamin. Dad keeps a BP of 110s-120s/70s-80s. Why the BP meds? Now he's scared and depressed about the other occlusions he did not stent and the other meds he had to be started on that he will most probably be on for the rest of his life.

I wanted to add that I asked Dr. A what my Dad's EF is and he stated, "Greater than 65% and his heart showed no signs of muscle damage." I really hope someone with more experience can shed some light on all of this for me. I don't know what to make of it all, especially Dr. A's resaoning behind not stenting the rest of Dad's blockages.

One week post cath and Dad says he feels good with no chest pain whatsoever, but he does say he feels a little "twitch" in his chest from time to time at no particular activity level.  What could this "twitch" be from?

[Hotspur]

I am 58 yr male with a 5 year history of High blood pressure had  CAD diagnosed after annual EKG showed right branch bundle block had angiogram and 3 drug eluting stents  , worst blockage was 95% of LAD . Non smoker  went from  196 lbs to 160lbs on low fat diet and 30 mins hard excercise  a day . Had second angiogram to get back comercial pilots license and all stents clear no new disease on 40 mg Statin and excellent lipid profile. 18 months later had stable angina pain which changed to unstable in 10 days followed by heart attack. Very little permanent damage to heart 2 more stents in LAD which was comletely blocked this time, went up to 80 mg Atorvastatin (max dose in uk) little improvement in lipid profile, 6months later  had 4th angiogram,  all stents were clear. The really good news fom the last angiogram is that some of the other blockages  which had not been stented had reduced from  50 % to 20 %  in only  6 months.  High level of statins appear to have reduced the plaque significantly in a fairly short period. There is real hope  that I may be able to eat sausage again.