heart attack vs stents vs stenosis

Posted by Sharon on August 04, 1999 at 14:44:05
I am 46 years old.  On March 30, 1999, I had a heart attack.  The following day I received 5 stents.  One in my LAD and 4 in my RCA.  I was a smoker, overweight, diabetic, high blood pressure, high cholesterol,family hx (my father died at 56 of a heart attack), stress and inactive.  I had it all.  I stopped smoking cold turkey, began a exercise program ( I was walking 2 1/2 miles per day), and limited my food intake to an average of 1368 calories per day with a 17% fat ratio.  I was doing good.  Within 8 weeks I was able to stopped taking my diabetic medication.  I was losing weight, I felt great.  I had a thalium stress test done at approximately 6 weeks, which I passed.  Five weeks later I began experiencing breathing problems when I walked, I also experienced chest pain while on my treadmill.  I went back to my cardiologist and had a thalium stress test done (which I failed).  The next day I was in the hospital for an angiogram.  The following day I received my sixth stent in my circuflex and I had roto-rooter (ablation) performed in the lower part of my RCA stent and upper part of my LAD stent.  I was told that I had scar tissue build-up.  A 99% blockage was found in the lower part of my RCA and a 95% blockage in my LAD.  I realize that there is no guarantee that scar tissue will not build up again.  I am not doing as well as the first time.  I am only up to walking a mile a day.  
Is it reasonable for me to ask my cardiologist to keep me on disability for an additional six weeks given my history of restenosis???  
This whole illness has been extremely devasting to me.  I have never had anything serious in my life.  What a shock.....

Posted by CCF CARDIO MD - DLB on August 04, 1999 at 14:55:34
Dear Sharon
I am sure the entire situation is very difficult. However, I would not recommend disability, as you do not sound disabled. I have never found placing patients on disability to be good for their physical or mental health (unless they really were disabled). The risk of restenosis peaks at about 3 months, but is present for about 6 months. The risk of new blockages forming is also present forever. Thus, going on disability for six weeks would not really protect you. Fortunately, your body has a warning system and you have symptoms when you develop a blockage. Make sure that you continue to take such symptoms seriously.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
Posted by patty on August 04, 1999 at 20:16:44
I disagree completely. I think you need to stay on disability as long as you feel you need to. Going back to work too soon can be devastating. You need time to heal physically as well as mental. The effects of this kind of illness can cause a lot of mental problems. IE: Am I going to drop dead any minute, Am I having a heart attack or is this just heartburn? How do I find the strength to be up on my feet 8-9 hrs a day? Cardiac rehab is the answer to most of these questions. You need to dedicate yourself to a cardiac rehab program. These programs run 36 sessions, 3 times a week for 12 weeks. It is very difficuly to work full time and go to rehab. If you have  a caring MD he will keep you on disability while you are in rehab. This will enable you to be in good condition to return to work. I speak from my own experience. Thank God I had a caring MD. I was able to return to work physically and mentally fit.

Posted by CCF CARDIO MD - DLB on August 05, 1999 at 10:32:09
Dear Patty
A formal cardiac rehabilitation program can be a good idea for any patient with heart disease, in order to get them exercising. While it is almost always necessary after bypass surgery, after an angioplasty, the recovery period should not be longer than a few days. I agree that if someone feels emotionally unready to return to work, it may be best for them not to. That they should receive disability income for a period of time that they themselves determine is unfair (to other workers) and illogical. It serves to promote abuse of the entire system (which happens quite a bit in our country). Doctors often are pressured by patients and families to put someone on disability. While the possibility of a recurrence of symptoms (and sudden death, as you suggest) does exist, it does not diminish with time - thus, the period of disability would need to be indefinite. In fact, this is what often happens - a temporary disability leave turns into a permanent disability leave.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
Posted by patty on August 05, 1999 at 20:09:45
Some of the things you say are true. It would have been very difficult if not impossible for me to work while in cardiac rehab. I can not leave work 3 times a week for 2-3hrs.The stress that trying to go to work and to rehab could cause another MI.My Boss insisted I stay on disability during rehab. At the end of rehab I was able to go back to work with no restrictions. I cartaintly did not stay on disability indefinetly..All of the people in my rehab class were on disability during rehab, and all of us returned to work at the end.By the way the fear of droping dead and other fears did go away after rehab. There are alway some people that try to abuse any system, but I feel heart patients need to have time to heal physically and mentally. It woul be far more unfair to co-workers to have someone on the job that has to leave 3 times a week or can not function fully due to short recovery time.

Posted by CCF CARDIO MD - DLB on August 06, 1999 at 09:24:04
Dear Patty
I almost always recommend cardiac rehab after coronary artery bypass surgery or after a major heart attack that significantly damages heart function. Usually, a period of disability is required during this rehabilitation process. After an uncomplicated angioplasty, I sometimes suggest cardiac rehab as a way for a patient to start exercising or to lose weight; I do not usually recommend a period of disability in this case. Of course, every individual situation is a little different.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.