Risks of the procedure

[Harvey]

I am a 57 year old male who has been in excellent health until a few months ago.  I do not have a family history of heart problems (my parents are around 90, in good health with no heart problems).  I started having some chest pains about 4 minutes into my  runs (4 times a week for 40-50 minutes).  I went to a heart specialist who ran an EKG and then asked me to come in for a radionuclide stress test.  The doctor then told me that I need a heart catherization and angiogram and depending on what they find, they may need to do the baloon procedure or even a bypass surgery.  His conclusions were as follows:

Perfusion Evidence of severe Anterior Ischermia estending from base to apex that redistributes completely, Normal LV Wall Motion and LVEF, Good Exercise Tolerance, No Angina-Like Symptoms Provoked, Mild transient ischemic dilation of LV with stress, Normal hemodynamic response.
I plan to get a second opinion.  My question is what dangers am I accepting if I do not consent to the angiogram?  Can I reverse the damage to my heart by radically changing my diet?  What dangers to I accept by continuing to run?

Thanks

[CCF-M.D.-KE]

Abnormal radionuclide stress test:

If the radionuclide stress test findings you describe are correct (anterior ischemia), I agree with your doctor that you need a heart catheterization. At this point there does not appear to be any damage to your heart. The test shows that there are areas of your heart not receiving enough blood during stress. This suggests that there are blockages in the heart arteries delivering blood to those areas. This finding means that you are at an increased risk of having a heart attack and of dying. Exerting yourself or running further increases this risk. I would not recommend continuing  to run or participating in any exertional activity at this time. If you were my father I would recommend getting a heart catheterization without a doubt.
The risks of a heart catheterization are very low, it is a routine procedure which involves very little patient discomfort. If you get a second opinion do so very quickly, such that this problem is addressed soon. Hope everything works out well for you.

Thanks for your question,


CCF-MD-KE

[No Bypass / No Stents]

The risk during catheterization is very low but you should set some parameters with your cardiologist before the procedure.

Remember that stenting is forever and stents fail about 30% of the time leading to further, more drastic procedures.  You should have strict parameters as to when and where you will allow them to drop a stent.

Also insist beforehand that you get a CD Rom of your images, so that you can have them independently evaluated and use them to track your condition over the years.

Also a person who is flat on their back after a catheterization is an easy sell for the higher value services (bypass surgery) that the organization sells.  Don't make that decision while you are flat on you back.  Leave the hospital, study the situation, talk, and have the results evaluated by another cardiologist before making that decision.

Stenting and bypass surgery are the best answers in some cases, but are tremendously over practiced.  Overall there is no evidence that they prolong life or provide a better quality of life other than for the people who practice the surgery.

Remember that the cash flow from cardiac procedures and surgery is all that keeps many hospitals afloat, and they need a fixed amount of raw material each day, so the advice that you get can be biased.

Aggressive lipid treatment with statins, Niaspan, and the other drugs now available, coupled with dietary, and lifestyle changes is sometimes a better answer.

Good Luck

[mr. fifi]

Please don't hesitate to have the procedure(s) your
doctor recommends.. And, ABOVE ALL, do not allow a
poster here, doctor or not, to influence you beyond
or against your heart doctor.

I had the *exact* symptoms and recommendations you
speak of and my stent procedure went perfectly, as
do far-and-away most of them.  No more angina, no
more symptoms.  Just follow what the doc wants you
to take (meds) and to do (new excercise regimen,
diet, etc) and your chances of a long and healthy
life QUADRUPLE compared to those who try to go
against what's recommended by the heart specialists.

And, of course they make their money doing those
procedures.  Isn't that awful.  Do not debate these
issues, Harvey, your life is at stake.  Literally.
Listen to your doctor.

Very best to you.

[No Bypass / No Stents]

When you first encounter a situation like this, you know very little about it, and most people tend to defer to the doctors judgement.  Most of my friends say things like "What did the doctor decide to do?".   My response is that it's not what the doctor decided to do, but what I decided to do.

The one thing that I have learned is that you have to take responsibility for your own health.  That means learning, developing judgement, and making your own decisions regarding your health.

I value the experience and judgement of my cardiologist, but I make the decisions, take the responsibility for them, an live with the consequences - not him.  

When you go into most large hospitals with angina pain, if you have insurance, you will most likely come out with a stent or a big scar in the center of your chest.  It's not necessarily because that was the best course of action for you, but because that's what they do.  Those are the products that they offer.  That's how they make their money.  That's not being cynical, it's just a business like any other.

Sometimes that's the best course of action, sometimes you have just become a victim of the thousands of unnecessary procedures and surgeries done in this country every week.

Remember that a stent is forever.  It's a foreign object in your coronary artery.  That artery is flexing with every heart beat, but the stent doesn't flex.  That artery is dilating and contracting dynamically to the needs of the body - not so the stent.  It might feel great for a year, but will it feel great for 30 years?  If not, you will be in for another more complex procedure or surgery.

Bypass surgery with venous grafts is good for an average of 7 years.  You're a young man - then what do you do?  Your natural arteries are now damaged and rendered useless by the surgery - there is no going back.  You a now a repeat customer.

And cardiologists and surgeons wouldn't do this if they didn't beleive in it - they do believe these procedures and surgeries help and save lives.  But they are deeply indoctrinated into this system, just like a fundamentalist Christian or Moslem is indoctrinated into their religous system.  They are not non-biased expert observers.

In the end you have to make the decisions regarding your health and you need to be wary of the medical profession, for your own good.

Good Luck.


  

[mr. fifi]

If one single person who reads these forums and
encounters a post such as those made by "no stents"
and hesitates for any time at all to follow their
own doctor's advice on these matters they are being
foolish, to say the least, Harvey.

Lives are often at stake in these situations, and
that is no exageration at all.  You probably know
that.

I repeat, do NOT allow crackpots with a bone to
pick come between you and your heart specialist.
If s/he says to get an agioplasty, and likely a
stent, do that without hesitation, no matter the
remarks made here by the above poster who seems
to feel the need to follow the doctors around
here and chip away at their learned responses.

My very best to you.

[No Bypass / No Stents]

I don't think that I'm a "crackpot", nor do I have a chip on my shoulder - just a different perspective.

I have no disagreement with the great advice of the CCF doctors here.

My main point is that, I believe, that you should seek the expertise and recommendations of your doctors, but ultimately make your own medical decisions, and take full responsibility for your health.

The cardiology departments offer mechanical and surgical solutions to coronary artery disease.  These solutions have considerable rates of failure and side effects.  Also they do not stop the progression of the disease.  They are not always the best solution and are over practiced for the financial health of some institutions.

Agressive lipid and BP management with the drugs currently available coupled with exercise and lifestyle changes can dramatically reduce the risk of cardiac events and halt or reverse the progression of the disease.  In some cases, a couple years of pharmacological therapy will be more effective than stents or bypass.

Yes of course we are talking about your life, but stents and bypass are no panacea.  Stents have a high failure rate, especially in small vessels.  In that event, you are in for more desperate procedures to correct the problem.

Bypass surgery has many largely unrecognized side effects such as significant cognitive loss, infections, and immediate failure of grafts.  This procedure is highly overpracticed.

Many cardiologists only pay lip service to drug therapy and don't keep up on the best combinations of drugs for lipid or BP therapy.  They make the big bucks and have the most fun swinging a heart catheter.  

I'm not saying this out of a bad experience, although I had 2 failed attempts at angioplasty, and was sold hard on bypass surgery.  My opinion comes from observation and having been around the system for a few years.

Of course you shouldn't give my opinion much weight compared to the CCF doctors here, but they must have a comment section for a reason, and I am sure that my comments are not out of line.

[Harvey]

Thanks to both of you for your advise and concerns.

I have gone to a second doctor who practices both traditional and "alternative" medicine.  He offers Chelation Therapy as an alternative to angiogram and/or angioplasty.  Are you familiar with Chelation Therapy and if I'm putting my life in jeopody by not going ahead with the angiogram?  I've purchased a book the doctor recommended to learn about Chelation Therapy called "Bypassing Bypass Surgery" - kind of a cute title.

[No Bypass / No Stents]

Chelation therapy is thought by most to be quakery.  I guess that I never thought that it would be effective enough to actually spend money on it.  There is a new variant of it now called NanobacTX - it's about $300 per month and is supposed to destroy the nano bacteria and their calcium shells in your coronary arteries.  I have investigated it, but am not sold.  I think that I would try a 3 month round of antibiotics first.

I would say that an angiogram is the best way to assess your situation.  Other than mess up your femoral artery for a while the risk is low.

Other than that the most important risk factor that you can work on is your lipids.  That would mean getting your total cholesterol down to around 160 or less, your LDL around 100, and your HDL as high as possible.  I use a pretty agressive cocktail of Lipitor + Welchol + Niaspan for that.  Even though my diet still includes too much fat, my lipid profile is excellent because of the drugs.

Those lipid pools in your arteries are the big risk for sudden death heart attack.  50 year old men who exercise and are healthy drop dead all of the time when they rupture.  The drugs will dry them up and lower your risk.  You may get some regression in plaques over a few years, if you watch your weight, diet, and exercise.

If you have even marginally high BP, you should address that.  I would say that an ACE Inhibitor like Altace would be the first drug to try in that case.

In my case I have severe 3 vessel disease.  I treat it as a chronic condition, take the meds, and push up against it physically each day.  I am physically limited, but do a lot more than most people my age.  My main goals are to keep the risk of a cardiac event down and not push my heart into future heart failure.

Good Luck.