Re: Trying to help my father through his heart disease

Posted By CCF Cardio MD-SGM on October 24, 1997 at 20:50:56:

In Reply to: Trying to help my father through his heart disease posted by Felicia Hirstreet on October 22, 1997 at 22:49:50:







: This has been a very difficult year for my my father.
Let me start at the beginning.  My father is now 67 years old.  He is a holocaust survivor and outside of his heart condition, has been in fairly good health.
In 1973, he had triple bypass surgery at New York hospital, and recovered nicely.
In November of 1996, he was admitted to Delray Community hospital with the expectation of having triple bypass surgery, and instead had an aneurysm and double bypass surgery.  He never fully recooperated, when in February, while experiencing angina, had a stress test and then an angiogram done.  He was told that his arteries were again clogged and that he was inoperable and nothing further could be done - at North Ridge hospital.  We had him airlifted to St. Mary's hospital in Milwaukee to see Dr. Dudley Johnson, where he underwent a twelve hour reconstructive bypass surgery.  He  was recovering very well, and then three months later again showed symtoms (symptoms) of angina.  We airlifted him back to Milwaukee where he had three angioplastys and one stent done.  His coronary arteries were clogged and we were told he has artherosclerosis.  Needless to say, we cannot continue taking him back and forth to Milwaukee.  He lives in South Florida and  is a real trooper.  I would greatly apreciate your advice.
Thank you in advance - Felicia
  






Dear Felicia,
Indeed your father has endured great challenges this year.  Let me first say that coronary artery disease, or atherosclerosis, is a progressive problem.  Bypass surgery, angioplasty, stents, etc.. serve to either bypass the portion of the coronary artery that is blocked, or directly open the blockage.  However, the coronary arteries are like branches of a tree, providing essential nourishment to the heart muscle through an ever-smaller network of vessels.  With further progression of the atherosclerotic process, more blockages downstream make attempts at restoring adequate flow difficult at  best.  As I gather, your father has undergone three bypass surgeries and a recent series of coronary interventions(angioplasties).  
At this point, two considerations come to mind.  It is important to ensure that he is on the maximal medical therapy for ischemic heart disease. Namely, nitroglycerine, beta-blocking medications if he does not have significant heart failure, aspirin, and aggressive therapy to lower his LDL cholesterol to below 100mg/dl.  Other medications might also be considered by an experienced cardiologist.  Second, if he reexperiences angina, it would be important to assess the status of the vessels that underwent bypass and/or angioplasty/stent. There is approximately a 35% chance of restenosis(redevelopment of blockage) at the site of angioplasty, although stents seem to enjoy greater success, with less than twenty percent restenosis rate at six months. That is to say that although angioplasty provides tremendous benefits for many patients, it is not a panacea for coronary disease.
I would recommend that your father undergo a stress test (thallium or sestamibi scan or an exercise echocardiogram) to look for evidence of reduced blood flow to the heart muscle.  If this is abnormal, then a repeat catheterization could be done. If the stress test is negative for ischemia, then aggressive therapy with medicines, as outlined above, would be in order.  If your father does have recurrent blockages that are no longer treatable with surgery or angioplasty, he could be considered for a novel therapy that has enjoyed some limited, but promising results.  This is known as TMR or transmyocardial laser revascularization.  Very small channels are created between the blood inside the pumping chamber of the heart and the muscle that surrounds it, in theory helping to provide oxygen to this deprived tissue.  This treatment is reserved for patients who have exhausted conventional therapeutic options for ischemic heart disease, and might be an option for your father if his symptoms recur.  Feel free to call 1-800 CCF CARE for a consultation with one of our cardiologists either here in Cleveland, or in Florida.  
Information provided in this forum is for general medical informational purposes only.  Specific
advice and recommendations are best sought from your personal cardiologist.