Re: I am not convinced

Posted By CCF-CARDIO-MD-APS on April 10, 1998 at 14:45:54:

In Reply to: I am not convinced posted by Judy Alcott on April 07, 1998 at 11:38:29:






My 45-year-old husband who has never smoked, never been overweight, is not a type-A personality and has always been active had a heart attack and double bypass surgery three years ago at 42.   He has always watched what he ate for at least the past 13 years (after his father died) and since he was hospitalized at 40 with chest pains he had been very faithful with his diet and exercise in addition to being on several daily meds.  He carrier nitro.  Last month he had a stent put in another artery.
Last week he was hospitalized for three days while they decided whether or not to put in another stent further "down stream".  They did not think it was necessary (what about his chest pains???) and presecribed Imdur for him to take daily.  I understand that this helps keep the arteries dialated.
Naturally he has a constant headache with these which make him irritable.
My question is, NOW WHAT?   My husband is not an alarmist so when he thinks he might be in trouble and has to take a Nitro, you pay attention.
Is there anything else to try?
Why didn't they do something five years ago when they discovered a 60% blockage, which is where he had his ("Widow Maker") heart attack two years later?
Should he just start popping Nitro and forget about calling the docs?
Will my husband live to see 50?
As you can see, we are both very frustrated and I am very scared.
Thanks!












  


Dear Judy Alcott,
Firstly you need to understand that no matter how much your husband has avoided the "bad things" like smoking and high fat diet, he has and always will have to contend with the strongest risk factor for coronary artery disease that there is- and that is FAMILY HISTORY!
Another point I would like to make before attempting to answer your question is that once a person has coronary artery disease, whether treated or not it is an ongoing process, and one only to be stifled by multiple interventions and an ongoing evaluation.  This concept by far is the most frustrating in my profession because
with all our knowledge and efforts we still can not impede the progression of coronary artery disease; although we recently have proof of decreased events(heart attacks, need for re-do angioplasty, etc.) in patients on lipid lowering drugs (examples are lipitor, mevacor, pravachol, zocor, etc.) it is not a cure.  It must be hard for you and your husband to hear that you will be dealing with recurrent chest pains and return trips to the cardiac catheterization lab for stents and such but on the flip side Judy most persons with such a family history in the years before surgery and angioplsty did not live past 40 years-ever!
So the answer to one of your questions is, yes your husband should continue to take the nitroglycerin tablets under his tongue and call his physician/seek medical attention in the setting of prolonged pain (greater than 25 minutes) and/or having to take more than three sublingual nitro's to relieve the pain.  Of course if ever the pain occurs at rest one should seek medical attention.  Actually these points should be made over and over again following each intervention that your husband receives so that an individualixed plan can develop in your minds.  It may help to keep a diary of the chest pains, when they occur, and how they are relieved.
In regards to the 60%blockage some years ago, it is generally agreed upon that no lesion less than 70% blockage needs intervention without some other reason (such as markedly abnormal stress test, severe symptoms not controlled with medicines)pressing the issue.  The reason for this is that physiologically flow is not low enough to put the heart muscle at risk when the stenosis is less than 70%.  The real unfortunate fact in cardiology is that ANY lesion regardless of its percent stenosis is a potential time bomb, this because mild plaque build up in the coronary arteries is soft in it's center, and for reasons unknown to anyone just yet this soft center can rupture at will so to speak and this causes an instant life-threatening myocardial infarction (heart attack).
Anyone with "some" or even "mild" coronary artery disease has multiple areas of these small soft centered plaques, most of which were probably formed as early as the teen years!  Lastly, there have been many advances and there continue to be many more on the horizon that do and will lead to better treatment of heart disease, it would be in your (you and your husband) best interest to continue care with a cardiologist who is very aggressive in treated the ongoing atherosclerotic process in the coronary arteries.  In lay terms, keep in touch with your cardiologist, give the cardiologist updates on the course of your chest pain and keep the diary on what helps, doesn't help, what medications have unbearable side effects (keep in mind that most headaches from nitro/imdur/etc. take 3 months to resolve) and most importantly
see a cardiologist who is up to date on the latest and newest treatments available so that with your physician you can make an informed decision on the risks and benefits of the latest and greatest so to speak. Well I hope that I have answered some if not all of your questions, and keep in mind that no doctor has ever been learned in predicting the length of life any person has left to live but a physician is learned in how to keep the symptoms at bay and try to halt the disease process.
Remember that information provided in the Heart Forum is intended for informational purposes only, any diagnosis or treatment of disease can only be made by your physician(s).  Any further questions would be most welcome.