Please review my Heart Cath....when you get time

I posted my January Heart Catheterization: http://sieg.com/CoronaryAngio.pdf

I was here posting with this thread in January - meeting nice people like Jack54

In this thread...I posed the question on Jan 18, 2009:
http://www.medhelp.org/posts/show/738406

"Can I survive Bypass Surgery with a 15% Ejection Fraction"

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Now I have greater concerns.  My most recent Viability Study on March 4...[Please read my Profile]

Shows that - I am not even viable for CABG...........but that's my PCP's discussion with me - from the report he got from the Hospital Surgeon.

I next go - to a Thoracic Surgeon in Portland Maine - to - you might say - hear from the "horses mouth" - just what do we do with your ulceration and 4 or so blocked arteries.

You see - the other half of my heart problem is CHF with a 15% ejection fraction.  I have elected to NOT have a heart transplant.

So - this is pretty tricky.  Can I be worked on - even in Cleveland.

Thanks.

Neil

[erijon]

I don't think you'll find anyone on this forum qualified to read a cath. You really need to post this on the expert forum and see if the doctor will look at it for you.

Good luck!

Jon

[Nealus]

Go back to post: http://www.medhelp.org/posts/show/738406

and you'll find some capable and intelligent people who CAN talk about certain issues - and they need not be Doctors.

Thanks for your input.

Neil

[erijon]

Understood, I know the people you're talking about very well, in most cases they are friends of mine, including Jack, and you are correct, they are very knowledgeable individuals all of whom I have great respect for. My only point here is that you are asking for an opinion on a specific medical test that none of us are qualified to interpret and want their opinion on a decision that will greatly impact your life. I respond to many questions on this forum, but none that I am not qualified to advise someone in a specific course of treatment in a situation as serious as yours, I don't want to take that responsibility. I would be more comfortable hearing from a doctor.

You're asking a lot from someone to help with a decision this serious, that's all I'm saying.

I hope everything works out for you.


Jon

[erijon]

FYI, I'm a fellow Mainer, Cape Elizabeth. I really miss home..............

[kenkeith]

I can only relate to the question you are not viable for CABG.  I was hospitalized 5 years ago with triple coronary artery blockage, enlarged heart, EF 13-29%, congested heart failure, etc.  The surgeon didn't want to operate based on the low EF.  The risk would exceed the possible benefit.  That is the call of a surgeon, and an operation would be a matter of life or death.  An EF below 29% is considered heart failure mode and surgery would usually not be an option.

Today my condition is normal size heart, and EF is normal, but I don't have any signs or symptoms of a heart problem (with medication) so surgery is not a consideration at the present time.

I have a totally blocked LAD (collateral vessels have bypassed),  circumflex is 72% blocked and not stented but treated medically, and the RCA 98% was stented.  The answer whether you can survive a bypass would depend on the risk you and your surgeon are willing to accept.  It really isn't an option for me as my doctor states I would feel better and there is a probabily I would have side effects, complications, not feel well, mentally a memory loss, etc.  Surgery may be less risky in the future, and a better expectation for a favorable outcome.

A heart transplant may be the best option depending on other factors, etc.

[Nealus]

erijon

Tell me the better url / forum thread to post my question to

And I do appreciate your input and comments and although I'm a Bostonian.......Eastport, Maine is my home and I'd do anything to help you - from missing "Home".....Email me - and we'll figure out something.

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kenkeith

You are a miracle of survival but you didn't explain much.  How the hell are you still alive today???

You said:

"The surgeon didn't want to operate based on the low EF.  The risk would exceed the possible benefit.  That is the call of a surgeon, and an operation would be a matter of life or death.  An EF below 29% is considered heart failure mode and surgery would usually not be an option. "

Again - how the hell did you manage that?  I'm 57.....what age are you - and what Vitamins are you taking....................honest-to-God

Neil

[erijon]

Just post on the Expert forum for heart disease, it's another forum in this website and is listed to the right. They only take 3 questions per day so try early and often. Those doctors are great and will be a big help to you.

FYI, I also lived in Foxboro for a few years, love that part of the country, haven't had good sea food since I left!

Jon

[erijon]

Also, if there was anyone's opinion I would listen to, it's Kenkeith's. There are a few others as well, but ken's great. The man knows his stuff!

[kenkeith]

Thanks Jon you are much too generous

QUOTE: "You are a miracle of survival but you didn't explain much.  How the hell are you still alive today???"

>>Treatment for CAD,  CABG, stent implant, or medication with exceptions, do not markedly if all reduce or prolong longivity.  Google the COURAGE study ...read for yourself it is no miracle that medication is as effective as interventional procedures.

Some exceptions: CAD patients may not be able to tolerate medication, the lesion(s) may be tortuous,  too large, location (blockage could be at the joint of a branch such as circumflex and LAD from the main artery, emergency, etc.  and stent may not be appropriate, then a CABG...age and general health is consideration and proper diet may stop the progression of plaque and some say reverse.  I don't see any hard evidence of that except from advertisements touting their product.

Do your research and you will find consensus many stent implants are unnecessary.  If I remember correctly the estimate is about 30%.  If medication effectfully dilates the offending vessel (proof would be angina relief), the risk for heart cell damage is marginal.  Sometimes there is ischemia without angina and that would be a risk!  



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