Dear Doctors & Friends,
My father is 79 years old and has had multiple heart attacks beginning approximately 15 years ago when he was airlifted to the Arizona Heart Institute in Phoenix, AZ. Within the last 10-12 years, he has had 3 angioplasty(?) procedures, i.e "balloons" to remover blockages. Has been on multiple meds including Toprol (?) & daily doses of nitro. He moved to the south to live near my older sister & me appx. 3 years ago. Within the last 18 months has been rushed to hospital twice for heart attacks. On the first visit, they took him down for heart cath with 3 surgeons were standing by ready to do angio/balloon, put in stents, or bypass, whichever they determined necessary as consent was given to whatever they felt was best. Well, they brought him back to the room without doing anything. NOTHING. They told my sister and I that he was not a candidate for any further procedures as his arteries we too small and too deterioated for stents, likewise too deterioated for balloon, and that overall, his heart was too damaged and too weak for bypass surgery, that he would not survive the surgery. They adjusted his meds, increased his daily nitro and sent him home. On the second occasion, they didn't even do a cath. Just got him through the worst of it, increased his daily nitro again and sent him home. On this occasion, they told us that his Left Coronary Artery, I think they called it the LCD (?) was totally blocked, a "total and complete occlusion." They told us that this particular artery is commonly called "the Widow-maker" and that he is lucky to even be alive at this point, that he is basically "on borrowed time." They did tell us that a couple of smaller arteries have attempted a crude form of natural bypass around the LCD and that's probably the only reason he survived. However, they were quick to indicate that these smaller feeder arteries would not be able to do the work of the LCD for an extended period of time. He has done pretty well for the last 6 months; however, seem to be declining rapidly now. I say this because within the last month he has started experiencing swelling in his legs, a first time for this, bloodwork showed that his potassium was depleted and he was placed on potassium therapy, and has been complaining of intermittent nausea. As of this week, he is complaining of numbness in his left leg. As a result, he is scheduled to see the doctor tomorrow. My sister and I fear that all of these odd symptoms may be indicators that another attack is coming soon. Are these symptoms: leg swelling, low potassium levels, intermittent nausea and numbness in left leg, symptoms or rather, precursers indicating that his conditon is getting worse and/or that another heart episode is soon to occur?? If so, or even if not, what are the signs that we should be watching out for, warning signs so to speak that he is getting close to another episode and/or perhaps coming to the end of his life. We don't want to lose him obviously, but have accepted the inevitable. At this point, we just want to know what we can expect to occur and in what order? What are things that will give us a "warning" that something is about to occur or that he is definetely getting worse?? We just want someone to be straight-forward with us and give us a realistic description of how this will progress until the "end." Please give me some honest information without the sugar-coating and the patronizing pat on the back like our southern gentleman doctors are so fond of doing. We are grown women and can take hard facts. We just want and NEED to know what the prognosis is, what are some things we can be watching for and we can expect to occur...
I don't think anyone can give you an exact answer to your question. Some people, like your fater die while they are asleep. If a person 'lingers' they tend to sleep a lot and only occassionaly wake up. They appear to be talking to someone. Also, a day or so before death, the skin starts to mottle (I'm not sure of the exact spelling of that word) where the skin appears to have large areas of bruising. Have the doctors set you up with Hospice where he can be placed in a Hospice center or alternitively, have Hospice come to you home on a daily/weekly basis? If not, you may want to check into that. Hospice is usually called when the patient is not expected to live more than 6 months. They can be a lifesaver. So many people ask about how long their loved ones will live on these posts; there is no way to tell you that. No one knows, not even the doctors. People that are expected to die in a couple of months live for years, like for example, my best friend who has been living with HIV?AIDS for the last 23 years! They gave her 18 months tops. Or like my own mother, they gave her 3 months, she lived 3 1/2 more years. No one knows how long they will live.
"On this occasion, they told us that his Left Coronary Artery, I think they called it the LCD (?) was totally blocked, a "total and complete occlusion." They told us that this particular artery is commonly called "the Widow-maker" and that he is lucky to even be alive at this point, that he is basically "on borrowed time." They did tell us that a couple of smaller arteries have attempted a crude form of natural bypass around the LCD and that's probably the only reason he survived"
>>>>The coronary artery you are referring to is the left ascending artery (LAD). About 5 years ago, I was ICU for several days for congested heart failure. My LAD is completely blocked, but over a period of time there is/was the development of collateral vessels that had by passed the total blockage...this is not an usual medical phenomonon and apparently your father has a natural bypass. I was hospitalized at the time for fluids in the lungs and periphery vessels. The problem of fluid accumulation is the heart is not pumping out an adequate portion of the blood received from the lungs. The blood backs up and fluids leak into the tissues.
I'm in the 7th decade of life, and I feel fine so don't write your father off without adequate treatment. I was told I needed a heart transplant but was too old! The surgeons did not want to operate as my heart was weak (EF 13-29%. I was shocked as I never had any ailments, and symptoms did not occur until chf. I began to make arrangements for end-of life.
A previous heart attack (MI) probably damaged heart cells and there is a loss of some contractility. This loss can be offset by reducing the damand for oxygenated blood, and medication. There may be a problem as medication may not be effective with restenosis of stent implants, I don't know!? Also, with a weak heart it is too risky for surgery!
Is the leg edema considered by tthe doctors to be due to right-side heart failure? It is possible the leg swelling is due to thrombosis (clot) as well as the pain. When the heart begins to fail the symptoms can be a dry cough, hypeventaltion, shortness of breath, unstable angina (chest pain with or without exertion), muscle fatigue, etc. This would be an indication the heart is not pumping adequately and if not properly and successfully treated the heart will enlarge and that will compromise further weakening of the heart and could cause a fatal arrhythmia (irregular heartbeat).
Treatment is to reduce the fluids with a diuretic medication, medication to reduce the heart's workload by dilating the vessels, and medication to maintain an regular heartbeat, and there is medication to increase the contraction of the heart.
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