cardiac quandary

[walt71]

ok here goes. had a chronic occlusion lad stented 21 months ago. one doctor said had small heart attack another said no, both top interventionals. a year later had echo and cath both normal. 2 weeks ago had echo that showed serious issues, ef 40-45 from 55-60 and multiple akinetic areas dr felt certain were from new blockage in an area that had been 50% previously. had cath TODAY and arteries are good, no progression, but there is reduced cardiac function and what amounts to systolic heart failure. I dont understand how I had a total chronic blockage with no heart failure, had it opened and lived for well over a year with no heart failure and in fact what should be improved heart function and now the heart is suddenly suffering systolic heart failure. I have not gotten a satisfactory explanation. any ideas anyone?

[ed34]

My mistake, its my blood pressure tablets I take as and when, but I take bisoprolol none stop.

[walt71]

oh thought u said u only take it sporadically as I was led to believe it should be taken continuously or heart would be confused, destabilized.

[ed34]

I have never had any issues with Bisoprolol. My heart needs it and if I forget to take it, I know about it. I don't take any supplements. The only thing I've found so far that has impacted on my heart disease is cut processed sugars down to 3 teaspoons per day. I was shocked to learn how much is put into pre-packaged foods and drinks. Sugar creates the tiny/sticky cholesterol in your blood. I've had no cardiac episodes in the last 3 years, which is a long gap for me. Fingers crossed, cutting right down on sugar may mean I won't have any more episodes.

[walt71]

was told w/ bb that need to take regularly as heart gets used to it, are you at all concerned that sporadic use will put heart on a bit of a roller coaster ride?  know or heard anything about carvedilol bb. also, what supplements if any do u take?

[ed34]

No, no issues with heart failure yet. I do get a small amount of hypokinsia when my heart is over 100 bpm. I take bisoprolol 1.25mg beta blocker. This is one of the more powerful ones and works wonders with no side effects for me. I remember when trying a different hospital, they told me to up the dosage to 5mg and my heart slowed to 28-35 bpm causing me to be hospitalised. However, 1.25 is a very low dose but still helps greatly with my angina.

[walt71]

so you have no issues w/ heart failure or areas that are hypokinetic?which bb do you take when u take it, does your dr think u should be on it continuously? any supplements?

[ed34]

The procedure is actually very simple and very fast. There are only 3 main vessels to check out. It depends on timing with heart attack, if you get treatment quickly enough, you don't lose any muscle. I believe its 20-40 minutes? I have been lucky enough to not waste time and get to a hospital quickly each time. I have only been wrong on one occassion, which is when I mistook acid reflux for a heart attack. The symptoms are very similar.

[walt71]

seems very rare and lucky that a dr would do ffr on a vessel that had no apparent stenosis and to pick the correct vessel, wow, beyond a needle in a haystack or maybe he tried more than one. am surprised you're not on long term bb therapy given I assume there have been significant mi events in past and it is remarkable if that is the case that the ef could be 70%. I thought all sufferers of myocardial infarction sustained a reduction in functional systolic capacity that is proportional to the degree of damage to the heart muscle. I don't understand why some people seem to weather heart attacks and others develop heart failure.

[ed34]

FFR is a tiny device which the cardiologist uses during the angiogram. It feeds back the blood flow rate to him wherever the sensor is situated in the artery. He put it at the top of one of my vessels, took a reading, then lowered it slowly further down the vessel, continually watching the readout. Half way down the vessel, the flow rate reduced by 50% and yet there was nothing showing on the monitor. My vessel looked normal with no irregularities. He put a stent there and the flow rate stayed the same but at the bottom of the stent it reduced by 50% so he put another stent behind the first one. This time the reading stayed the same all the way down. On that occassion there was no reduction in systolic function. So with my experience and my cardiologists, we learned everything isn't as it looks on the screen. I was on beta blocker but only take them when I feel angina now. I have a lot of blockages still existing in other arteries so angina is a problem with me. I have reduced systolic function at 120 bpm and above due to the blockages but below 120bpm my heart is perfect. My EF is 70%.

[walt71]

a little confused. to touch above question, solely regarding ffr episode, besides elevated enzymes was there any indication via echo or cath of reduced function? was there any %stenosis in the area they stented? if not how did they identify it as the problem area? do you currently have any left ventricular dysfunction or systolic heart failure, any symptoms? sorry for all the ?  but also do you take bb,  just started carvedilol and very fatigued.  am feeling increasingly concerned that dr judged ffr unnecesary due visual observation as I am not feeling confident in my status.

[ed34]

my FFR was a different heart attack to the one where I had left ventricular systolic function. My reduced systolic function was when I had a 90% blockage during my second attack in 2009. Then in 2011 I ended up in A&E again with chest pains but these disappeared. My troponin test was negative but they kept me there for 12 hours to test again (protocol). To everyones amazement they were elevated so I was taken for an angiogram. It was this time where nothing was spotted, no new blockages. The cardiologist was very willing to perform FFR, he thought it was a great idea and this is how we found an anomoly. My artery lining must have been very rough causing my blood flow to drop by half, when nothing could be seen on the monitor. 2 stents later and blood flow was restored. I have angina on exertion now, but my EF is 70%. Since cutting processed sugars out of my diet (well, I've limited myself to 3 teaspoons per day) my cardiac events seem to have stopped. It has been the longest time between events now, 4 years.

[roybatty]

not to get too redundant but do you remember what they characterized the blockage as in terms of % stenosis and were they resistant when you pushed for the ffr, skeptical and then surprised as I am increasingly annoyed that my own ffr was aborted due to normal appearance. also, you seem to have an extensive cardiac history, due you have any systolic heart failure? left ventricular dysfunction?

[ed34]

It started with angina and they did an echo which showed reduced systolic function on the left side, which led to angiogram.

[walt71]

forgot, when you had the problem with vessel corrected via ffr did you have reduced systolic function evident or no, it was purely symptomatic? thanks

[walt71]

computer screwed up. anyway I said on the table aren't you gonna do the ffr and he said no need. he is supposed to be tops in the cath lab but I have a real problem with him now as he doesn't like my multiple questions and has no real answer for functional deterioration. just says take bb. am quite troubled by this and certainly dont want cath redo.

[walt71]

thanks for reply. am very frustrated b/c dr. said at meeting that he would do ffr on suspect vessel but during procedure decided it wasn't needed and I even asked him on the table   are you gonna do ffr and he said it wasn't even nec

[ed34]

If FFR is normal in all vessels, then perhaps they could look for a virus as a culprit.

[ed34]

No it doesn't add up at all and I too would be very concerned. I think you needed a much more in depth angiogram. Nearly all angriograms are just observations with no tests performed. If an artery looks clear, then it is taken there are no issues with it. I was in this situation a while ago, when during the angiogram my arteries looked exactly the same as before. It was then that I suggested doing FFR where a tiny sensor is passed along the catheter which measures blood flow. They looked at the reading at the top of my Left Circumflex and slowly passed the sensor down the artery. When it reached halfway down, my blood flow was cut in half. There was nothing on the screen, but he put in 2 stents and it fixed the problem. All is not what it seems on the monitor screens.