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coronary ectasia
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coronary ectasia

I have just been diagnosed with coronary ectasial. I am female, 48 years old, with high blood pressure and high cholesterol.  I am not overweight, I have always exercised daily, and my diet is relatively healthy.  I have been having chest pains on exertion, and am frequently out of breath.  The high cholesterol is hereditary.  I would appreciate any information on this diagnosis.  And, is there a cardiologist at the Cleveland Clinic who has experience with coronary ectasia?  Thank you, Trish
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74076_tn?1189759432
Hi Trish,

Coronary ectasia are dilations thoughout the coronary arteries.  I don't know if anyone that specializes in them, but we all see them in clinic and the cath lab.  

There is a continuum of disease meaning some people have only mild ectasia while others develop severe disease.  There is a known relationship between people with one gene for familial hypercholesterolemia-- you may have this.  There is no known treatment, however I would aggressively treat high blood pressure and cholesterol.

If the coronaries become too ectactic, we sometimes start a blood thinner called coumadin to prevent clots, although there are no guidelines for when to do this.

Marian Thamalarison at the Cleveland Clinic does not specialize in ectesia, but I trust his judgement and he is a very compassionate physician.

I hope this helps and thanks for posting.
13 Comments
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Avatar_n_tn
Hi,

I am new here but I have trouble posting questions.  Whenever I click on "Post a Question", I get "Dear Friends,  We are very sorry, but this Forum has reached its limit for new questions today. Med Help has to limit the number of questions we accept on a daily basis, due to limitations of staffing and funding. Our forums 'reset' to new questions at a different time every day. We do this in order to give people in all time zones a chance of getting their questions answered....".

I have been trying once an hour today but it keeps giving me this error message even though this coronary ectasia question has been asked.  Please help!!!... thanks! :-)
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Avatar_n_tn
post 8 to 10 am EST.
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Avatar_n_tn
I just saw my doctor today and he told me that pfizer has just finished phase III Clinical trials and is now applying for approval from the FDA and he said the drug should be on the market this spring. I can't find information on Pfizer's website confirming this but he said he had just read it in a journal that he received. I know you are waiting for the drug as am I and my doctor himself. I hope this is true, it would be a lot earlier than we expected.


Erik
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Avatar_n_tn
The forum only takes 1 or 2 questions a day and then stops. With many people trying it can take quite a while to get lucky.It took me 6 months the first time
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Avatar_n_tn
Just what drug are you talking about, what is it for
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21064_tn?1309312333
I have seen Dr. Marin Thalmilarisan and he is a wonderful and very knowledgeable physician.  Should you have the opportunity to see him as a cardiac patient, I am sure you will be happy with his sensitive and caring manner.

He performed my TEE a few years back.  He also called me at HOME when I was having some serious questions regarding the potential need for valve surgery.  That's a really long story, but the short of it is that he is a fabulous cardiologist.  I highly recommend him, and in fact, I will return to him should the need arise.
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Avatar_n_tn
This drug is a CETP inhibitor which blocks an enzyme in the liver that prevents HDL being transformed into LDL. It results in substancial elevation of HDL (the good cholesterol). The drug, Torecetrapib, will be in combination with Lipitor which will lower the bad cholesterol and raise the good cholesterol and be a cutting edge treatment for the prevention of Coronary Artery Disease. This drug will actually cause a reversal of plaque buildup in the coronary arteries. Good news for anyone at risk for heart disease.
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Avatar_m_tn
Thanks for the info on Torecetrapib.  I wasn't expecting it until 2006.  I do know that they are building a new plant in Ireland to produce it, so they must be pretty confident that it will get through trials.

When (if) the drug comes to market, I will probably drop my three meds (Lipitor, Whelcol, and Niaspan) and just take the combo drug.  That will be my first major change in several years.

If this drug proves to be safe, I believe it will save a lot of lives that would otherwise be lost to coronary artery disease.  It should also greatly reduce the need for stenting and coronary bypass disease, although the mindset of doctors about the best treatment for CAD will have to change, and that will take much longer.  Of course the patients will still have to exercise, if they want to live.

Also stenting and bypass surgery is just one great cash cow business and there is tremendous cultural indoctrination that this is the best way to treat patients.  

My doctor get's $175.00 twice a year to give me a quick checkup and renew my presciptions.  He can make $20,000 for his doctors group and the hospital before lunch swinging a heart cath.  He told me that they usually tell guys like me to get lost, but whatever I'm doing seems to be working, so he's going with it.  I'm trying to educate the poor guy, but he just feels lucky to be an associate of the group of cardiologists that he is with and they are making good coin practicing the old school stuff.

Thanks for the info and take care.

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Avatar_n_tn
I agree with you. Cardiac Catheter labs will lose a lot of business because of this new drug, although they will cater to the majority of cases that never take care of themselves and never visit a doctor until their CAD is advanced to the point where only interventional Cardiology is their only hope. You are the excpetion, not the rule. If you could get a few more cardiologists on your boat, you could re-revolutionize cardiac care.

You take care and hopefully this coming summer sees us both on Torcetrapib/Lipitor.


Erik
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Avatar_n_tn
Yeah...vioxx was considered safe...remember?  Also, remember SSRIs for kids until it got a black box.

Some advice, just like my brother says (hes a mechanic) that you should always wait until the next model year before buying a newly introduced car model, wait until all the bugs have been worked out...you should always wait a year or two before changing meds...IF YOU CAN WAIT.  Seems like you can't wait and that's unfortunate.

There are so many conflicting studies on HDL and the role in its reduction of CAD.  The only studies that are NOT conflicting is the reduction of LDL. PERIOD.  People get heart attacks with low HDLs and High HDLs, low trigs and high trigs etc.

If you believe in a n=1, buy the book 8 week cholesterol cure...the author had two by-pass surgeries within several years of each before 40 and then started his oat bran and niacin regimen.  10 years later he had his angiogram to see the results...second by-pass looked like the day it was put in.

Now, the author of this book is a big proponent of HDL to TC ratios...but again, this is an n=1.  But what about HDL to LDL ratio's or the inclusion of cRP's or homosysteine levels?? What is the best marker to watch? I worked with the worlds expert on cRP (inflammation marker) and he swears that the best marker to watch is cRP and your HDL to TC ratio but has no long term proof. IF your watching markers and just focused on one or two you may be missing the BIG picture.

As another smart DOC keeps reminding me "Gray hair is marker for increased stroke risk, but dying your hair black won't eliminate that risk."  Think about that as you get your one HDL marker just right "in your opinion." Is 45 high enuf for your purposes?  How do you know?  Is even 75 high enuf? How do you know?  President Bush has an ultra low cRP and the white house docs had to call this cRP expert to comment on what it meant...Nobody knew! Good luck in deciding on what is a good HDL without any long term study, esp with this new med.

My bottom line...waiting for another drug to help do what you should already be doing overall (diet, exercise, stress reduction) is possibly just another example of having the wrong midset.
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Avatar_n_tn
Hi. I do appreciate your input. It's actually a very intuitive way of describing it. You are right on many of your points. The only thing I would say is that some of us have failed to raise our HDL through diet and exercise and have to rely on Medications to help us. I think what Healthyself and I are doing is attacking all the angles you mentioned. 1)CRP 2)total/HDL ratio 3)exercise 4) LDL


We just need medication to help us. If we didn't do our part then the medication would be useless. Thank again for your post.


Erik
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Avatar_m_tn
Yes, all medications have some side effect and some prove to be dangerous, even after they have been approved and get to market.

The data on the relationship of lipids to coronary artery disease goes back over 40 years and has remained pretty consistent.  The importance of maintaining a good ratio of HDL to LDL has also been known for many years and has been used in life insurance physicals for many years.

I have made some improvements in diet and lifestyle, but it is very difficult to become a Dean Ornish follower for some of us.  My approach to life is eat, drink, exercise, and be merry and take multiple cholesterol drugs.

The Lipitor/torcetrapib combo should be the first big step in lipid control since the statins where introduced.  If it does make it to market and proves to be safe, it will save many lives and drastically reduce the need for bypass surgery and stenting.

Pfizer has also bought Esperion Therapeutics.  They have created a genetically engineered form of HDL which reduces plaques in weeks.

You can read about that at:

http://www.wallstreetnewscast.com/news/12222003.html

Best Regards

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