question about cath results

[bsn]

I have a question about my recent heart cath. I was told I had no blockages just that my right coronary artery is very small and gets narrower the further down it goes. I don't know what that means and unfortunately I was very drowsy when the dr came in to tell me this as the sedated me for the cath. All I know is my Verapamil was increased to 240 mg and my Crestor was increased to 40 mg. Is this a normal finding or a potential problem? I think everything is ok as I was told that I'm just one of those women who have chest pain for no identifiable cause and all I need to do is follow up w/ my PCP.

If it makes a difference I went to dr for chest pressure, sob and nausea. Hx of htn, high chol (398 the day befor cath), endothelial dysfunction. Strong family hx of early heart disease- mother died of MI age 59, father died of MI age 60, brother has CAD, CHF and had stent placed at age 35.

Should I worry about this or just say everything's fine and get on w/ life?

[CCF-M.D.-MJM]

Hello BSN,

I am sorry to hear about your concerns and symptoms.  It is always difficult to interpret the results of a cath film without seeing it.  I have seen normal small right coronaries in the setting of very large left sided systems.  The reality is if you have a strong family history of coronary artery disease and known endothelial dysfucntion,  you should be treated like you have coronary artery disease with maximal risk factor modification.  That does not mean you shouldn't get on with your life.  My advice would be to reduce your saturated fat, eliminate trans fats, exercise, do not smoke, and continue with risk factor modification.  I would check your cholesterol in a few months to make sure it is responding to the crestor and make sure the medication matches the needs of your cholesterol panel.

I hope ths answers your questions.  Good luck and thanks for posting.

[runnertom]

I wonder is you have diffuse plaque, or lesions are are more or less unformly distributed along the length of the artery. According to Dr. Lance Gould in his book "Heal Your Heart", this diffuse narrowing can be as restrictive to blood flow as localized narrowing. Unfortunately, or fortunately depending on your point of view, such narrowing is best treated medically rather than surgically. This may explain your change in medication.

[Al Dente]

Hi...

Sounds like you aren't having alot of fun, but I'm glad you came through your cath ok.

Coronary vessel anatomy can be a challenge to diagnose and treat--small vessels can be quite tricky.  I have some very large caliber vessels and some that are very, very small.  Intravenous ultrasound (IVUS) can be very helpful in reviewing plaque and vessel wall/media thickness.

Women (and some men too) can have a type of coronary artery disease that is distrubuted along the vessel walls without having big chunks of obvious plaque--again IVUS is helpful in this diagnosis.  Like runnertom points out, diffuse CAD can be tricky to deal with.  I inherited a good chunk of my mother's bad cardiac genes, and she suffered with angina for a long time before things went bad for her.

I have early onset CAD--many family members have had CAD related issues and early death.  I was diagnosed at 28 with CAD and have a stent in my RCA and have diffuse CAD (a bunch of other plaques).  I too am felt to suffer from endothelial dysfunction and have familial hyperlipidemia.

Crestor is a good medication in my opinion for aggressively treating lipid issues, and in combination with Zetia works well (I'm not a doc, just discussing my own experiences as a heart patient).  I was on Lipitor for nearly 10 years (my TC was in the 450s in my mid to late teens) and it helped me from having an issue earlier.

Are you diabetic?  Controlling hypertension, diabetes, and cholesterol are essential in combating CAD and its progression.  Once you have it, it's there to stay.  Cardiac small vessel disease can be a chest pain culprit too.  A family history of lipid issues and heart disease shoots up a big flare.

DO NOT accept that you are just a "lady" with chest pain...this is where many docs go wrong and the healthcare community in general.  It's even worse if you are a young person.  I wish you good luck!

[bsn]

No, I'm not diabetic (yet). I have hypoglycemia but all of my siblings, both parents and my grandparents, aunt and uncle are all diabetic. they tell me I will develop diabetes at some time as the hypoglycemia is my body's way of telling me it can't control my blood sugars very well.
I try to protect my health where I can but am becoming very discouraged because my dr can't seem to find a cause for my s/s. I feel like I'm imagining things but I know I feel lousy quite often. I am not the type to go to the dr for nothing and I don't have any issues with anxiety so that's not my problem. Actually the people around me are the ones who get anxious because of how my color looks and that I frequently am seen holding my chest while I'm obviously SOB. One of these days the dr will figure out what is wrong and fix it, I hope. In the meantime I'll just keep on doing what I need to do. Thanks for your input!

[Al Dente]

Hi bsn, sorry to hear of the rough go.  no you're not imagining things.  cardiac small vessel disease is extremely difficult to treat, and diagnose.  you could hear alot of things thrown around like anxiety or panic attacks, or upper GI disorders.  Those two need to be ruled out.  there's no amount of SSRIs that will take away a cardiovascular problem, and PPIs might kill off heart burn, but it won't make angina go away.  In my opinion, heart pain and heart burn do not feel anything like each other.

Right now, there are a few meds that help combat small vessel angina.  Long acting nitroglycerin, calcium channel blockers, ARBs, and maybe betas.  Betas help relax the heart and lower bp, but have some drawbacks in treating this condition.    

Treating any issues with insulin resistance is also key (from what I've been told, once a diabetic, your always a diabetic--you help control its course with diet, medication, & exercise).  Metformin, Pioglitazone (Actos), & Januvia as an adjunct is on the bleeding edge of treatment.  Some cardios might not be onto this.  Good ones and endocrinologists are heavily into this.  Docs throw in ASA and Plavix for extra safe keeping, especially if you've had a stent or are at stroke risk.

Treating the underlying cholesterol disorder & insulin resistance can help with endothelial dysfunction.  I have had very good luck with the above treatment.  I see two very good cardiologists (one preventative, one invasive) at top tertiary care hospitals.

Caths are the gold standard, but depending on who's doing it and what your body is doing at the time can convey different outcomes.  I have had 5, and things varied quite frequently--and so did the opinions of the readers (cardiologists).

This is a long fight and there are no quick fixes.  All in all, it has taken me about 2 years to feel better without angina--I was classed at CCS Class IV angina.  I wish you good luck!

BTW, I know the feeling of having everyone look at you when you don't look that hot.  Try and work with your docs.  If you're not getting solutions and getting better, get all of your data & test results, make an appointment and get to another hospital.

[DebHasPVCs]

Al Dente -- I know you're not a doctor, but you seem to know a lot about cardiology based on your own experiences.  I wondered if you would take a question in an email... I don't want to bother everyone on the board.  If it's okay to email you, please let me know at ***@****.  Thanks so much!

[discobeat]

I had similar findings.  I never really had symptoms, but due to cronic a-fib, they ran the nucluer tests, and when I failed those, I got a caths both times.  The cardio told me after the PET scan that I would need a  bypass of my right main.  The angio showed no blockages and no further explanation was given.  Now that I am getting classic symptoms as I get older, the doctors have told me to take an antacid.  

I am left to wonder if there is a narrowing of the artery or am getting spasms.  But I adjust to the symptoms and take hope in the clear finding to give me the incentive to exercise up to my limits and not worry.

[Al Dente]

hi everyone,

i appreciate everyone's support and comments.  i'm just a heart patient that's spent alot of time working with doctors to treat my condition (and spent alot of time with sick relatives suffering from heart problems).  you can also gain some info by doing some searches--alot of information is available on-line.

you should always talk with your doctors and ask them questions--and of course seek medical help right away if you don't feel well.

i take interest in my health and am trying to get back to normal as possible.  my case has been rather difficult to treat, and i've used my research skills to help.

take care!

[bsn]

Thanks everyone for your comments and especially thank you to the doctor. I feel alot better just knowing that what I feel is something and not just me being a hypochondric (which I would have hated!). I'll see my PCP next week for follow up and keep insisting that my s/s be taken seriously. What I find so sad is that I'm a nurse and if I can become this confused and made to feel "crazy" what is happening to people who don't know how to navigate the system. Hopefully this will all make me a better nurse and I will be able to make my patients feel free to express their concerns and know that their input is vitally important!

[Al Dente]

Hi BSN,

This can be a really difficult and challenging time.  On one side you know something's not right, and on the other you are trying to believe your caregivers--however sometimes you have to fight the system and get to the top docs.

Assumptions are deadly in healthcare.  I don't know how many times that I was told that I had heartburn--my caths showed 3 vessel diffuse CAD...I'm a young person and people at smaller hospitals had a hard time understanding it.  Small vessel is whole different boat that takes alot of patience and time to diagnose and treat.  Like BJK says, there can be alot of variance depending on who reads the cath.

Up to 1/3rd of EKGs don't pick up cardiac problems.  They won't pick up a small vessel attack--your pain is real, but it's not enough to cause damage.  Given enough repetative events, however it can cause larger issues.  There's nothing out there that technically and definatively diagnose small vessel except a series of symptoms.  Some people with CAD have both small and large disease.

I understand what you are going through and have been through the ringer with alot of docs and hospital stays.  The top guys and girls at tertiary care centers are very helpful.  

Take care.

[Phoenix48]

Hi, im really new at this but i just need advice. I'm an 18 year old female, who was just recently diagnosed with supraventricular tachycardia, and boy has it been scary. I had chest pains, shortness o breath, palpitations, numbness in my fingers, and i just felt awful. When I was finally diagnosed, i went to a clinic in florida to have a catheater ablation done, to burn the extra node i had, causing me all this trouble. When the procedure was over, the doctor told me that he didn't get everything, but i should not experience any more problems, despite this procedure being sucessul 95% of the time. After a few weeks, i still thought my heart was racing and my hand and feet would start racing. I went back to the doctor, and he told me to take a stress test. My stress test showed that everything was back to normal. I have been taking beta blocker medicines for about 1 month now, and am basically suffering from anxiety, because o all i have went through. i hope im ok, but i still worry that my heart my race again or might simply just stop.. anyone have any advice, suggestions or encouragement?  

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