First of all, a little history from my reports.
Ischemic cardiomyopathy, CAD, MI, Cardiac arrest; inductable vtach, chronic angina, atrial fib, ventricular fib, dislipidemia, syncope, sick sinus syndrome, severe hypokinesis of the anterior wall, anterior septal wall, and the left ventricular apex. Also a marked anterior, septal, and apical perfusion defect with absent tracer uptake extending form the basil to the distal left ventricular segments which revealed no evidence of redistribution on the delayed images.
LVEF of between 20% and 35% according to which test and when. Pulmonary artery systolic pressure estimated at 44 mmHg consistent with pulmonary hypertension.
8/26/03 I was told after MI that I only had a 10% plaque in my arteries and nothing was done until it reached at least 50%.
01/18/04 Second MI was called acute with total blockage of one of the arteries. Reports also say I was in cardiogenic shock. Have a large scar on my anterior wall. EF 18-22%.
3/30/05 Third and fourth attacks were more like passing out. The first of these I didn
Question 1: What is the stuff about hypokenisis, perfusion defect, ejection fraction, and pulmonary hypertension.
The hypokinesis is an area of damaged heart muscle that still contracts versus akinesis which is an area of heart muscle that doesn't contract at all. The perfusion defect they describe is scar -- dead myocardium from your heart attack. Ejection fraction can vary depending on the type of study and inter reader variability. You have a moderate to severe reduction in your ejection fraction -- that is the take h ome message. You have mild pulmonary hypertenion, most likely caused by your LV dysfunction and heart failure.
I just thought I would add my "two-cents" into the picture... Dwolf - Before I begin, I want to let you know that I am currently a second year medical student with WAY LESS expertise and much less knowledge than the CFF MD's that post replies on this forum... So before I yield my limited bit of knowledge (Knowledge that is mainly associated with the fact while in medical school I have developed this absolute fascination with the human heart), I definately want you to consider the expert before me... So here ya go... In reading your post I could not help but think that you would be a perfect canidate for Carvedilol. Carvedilol is a nonselective beta-blocker with intrinsic alpha-1 blocking capability. Here is what I have learned about the medication that made me feel like it would be beneficial for you to discuss with your current cardiologist... (By the way, the below information is cited from Carvedilol: Beta Blockade and Beyond, Alice F. Stroe M.D. & Mihai Gheorghiade M.D. - Rev. Cardiovasc Med. 2004; 5(suppl 1):S18-S27)
Chronic heart failure is associated with an increase in both atrial and ventricular arrhythmias. Carvedilol has a demonstrated antiarrhythmic effect, especially in patients with ischemic cardiomyopathy, which may result from several different
electrophysiological mechanisms. Adrenergic receptor blockade itself is well recognized to reduce myocardial ischemia and to improve arrhythmic thresholds. In addition, carvedilol possesses membrane-stabilizing characteristics, as well as the
ability to selectively block important electrophysiologic calcium, sodium, and various potassium channels, including both the rapid and slow components of the delayed rectifier current and the transient outward potassium current.
Thank you for the information. I will bring up the Carvedilol to my doctor on my next visit. I guess, being a fairly young person, I just don't understand why this keeps happening. Trying my best to understand whats going on but you only get a few minutes with the doctors and I forget half of what I want to ask. Again, thanks for the info.
Yes your correct, Coreg is another name for Carvedilol... To my understanding, Carvedilol/Coreg was initially introduced as a drug therapy for CHF patients but from what I gather from medical research reports and literature, it has also been found to be benefical with other patients presenting with clinical pictures other than CHF. I do know that Carvedilol/Coreg is absolutely contraindicated in patients with decompensated heart failure.
Thanks for the extensive info on Coreg. I would appreciate your input on whether I indeed could take Coreg. After recent stent implant I have been left with a dysfuntional LIMA bypass and slighly funtional LAD besides other RCA and LCX blokages. A recent stress test indicated a large area of reversible ischemia in both anterior and inferior sections. I have always had PACs and PVCs after triple CABG with AVR and aortic root repair 5 years ago. Atenolol initially helped with these but after 2 weeks pronounced PVCs compelled the cardios to stop atenolol with the advice that I was somewhat allergic to Betablockers. However 5 years later and after my recent heart work I am being strongly advised (including CCF cardio) to start taking Coreg 3.125mg. Do you think I am a candidate for Coreg? Any comments would be highly appreciated. Thanks, ChrisR.
Chris - Unfortunately, I am only a second year medical student with WAY LESS expertise and much less knowledge than the CFF MD's that post replies on this forum... So, the limited information I yielded previously is mainly associated with the fact that while in medical school I have done extensive research relating to cardiovascular medicine and in doing so, developed an absolute fascination with the human heart (It truly is an amazing organ)! SO, I definately want you to consider the expert before me... But, for what it's worth, if I were you I would do as much research on my condition as I could... There are many sites on the internet that I have found helpful in my quest to ascertain the latest information in cardiovascular medicine (Note: You have to be careful which sites you get your information from because there tends to be a lot of bias out in the world of cyberspace with regard to the numerous types of pharmecutical medications used in cardiovascular medicine - REMEMBER, the pharmecutical industry makes BILLIONS of dollars each year!)... Being a medical student, I am able to access for free a multitude of medical journal sites from my school and if I were you I would prefer to stick with the information yielded from these sites... I'm not sure your financial situation but you may want to consider purchasing an online subscription to a medical journal site that you feel may benefit you in your quest for information - The Journal of the American Medical Association (JAMA) is a good one, kinda expensive, but it does provide a bunch of information. You may also want to consider lookin at these following free medical journal sites, they provide web access to past issues and many of their information is available in PDF so you can print out the information you recieve and provide it to your physician... Here are some of the sites:
Good luck in your quest for information... Sorry if I didn't provide an answer you were looking for but as I mentioned before, I am only a second year medical student...
I read this post and asked my doctor to give me Coreg. He did. I do not have CHF but some sort of a heart event called NSTEMI. It is like getting ready to have a heart attack. But who knows! He took me off the TOPOLXL 75mg and put me on Coreg 12.5 x 2 a day. Talk about side effects at that strength. I called him in a zombie/ twilight zone and he told me to get back on the TopolXL till next week when he sees me. What this cardio doc of mine should of done after reading up on this med is to start me off low and slow, i.e. 3.5 mg x 2 a day for a week or so. Then 6.5 mg x 2 for a week or so and then graduate to the 12.5 if needed via the Echo reports and EKG. Wonders never cease with my doctors! But what do I know? Right! (-: Good Luck to you. Take good care and question everything.
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