small vessel disease

[kendrad]

My mother had open heart surgery a month ago, and ended up coding 3 times.  Her first code was 8 hours after surgery and they had to do an emergency  reopening  of her incision in the ICU room to get her heart beating, and  to remove a blood clot near the heart. Her longest code was for 32 minutes and occurred after a procedure to close a hole in her heart that is hard to detect, and was suspected a few days after surgery as they could not stabilize her.  She is still in the ICU and suffered mild to moderate strokes, but she seems to be mentally aware.  She is going to need much rehabilitation,but seems to be getting better every day.  I am thankful she is alive, but do not know what caused so many of her complications.  I am also concerned as she has another blood clot above her trachea collar,but they are afraid to remove it with her bleeding problems.  We did not know how serious her problems were as her Doctors previously had said she suffered from an anxiety disorder and she has been on Xanex for years now.   My family and I are suffering much guilt for not realizing that her condition was something much more serious.  She is only 60.
Her surgeon told me that she has small vessel disease, and that is is hard to detect.  He also said that my chances of having it are great as it is genetic, and the only way to detect it is with a heart scan.  He suggested I get tests  done to see I have the disease as well.  I am now concerned as the cardiologist I went to see told me that he wants to do a stress test, and does not think I need a heart scan.  I am now confused as to which specialist to believe.  How do a get a correct diagnosis for small vessel disease?  Also, can you tell me if small vessel disease causes blood clots?  Any other comments and suggestions are much appreciated.  I am trying my best to make sure my mother continues to get better. Thanks for your help

[kendrad]

Thanks so much for the info!  I have so many questions regarding my mother's recovery from the strokes she has suffered.  Did you have any vision loss after your stroke that improved later?  Also, were you able to do controlled hand movements right away or did it take you awhile?  My congratulations to you for being so strong, and able to recover from your trauma.   I can't begin to imagine how frustrating and scary it must be to suffer such an event.  My mom has a good attitude, but she is starting to get extremely sad. Thanks, again for the links and information!
Kendra  (:

[Jack54]

So sorry to hear about your Mother and all that she has been through. Was her open heart surgery due to coronary artery disease (CAD) which required a bypass or due to another problem? I am pretty sure that the "hole in the heart" can be repaired w/o surgery.

Anyway, I have small vessel disease (SVD) in my brain and in my heart. An MRI can diagnose SVD of the brain and an angiogram via cardiac catheterization can diagnose SVD of the heart. This is how I was diagnosed. I have had a heart attack and 2 strokes. I sometimes walk with a weird gait or limp, and I am a little bit crazy at times :) Really the strokes affected my thought patterns and personality much more than my body. My mouth is drawn a bit on the left side. These strokes were not the hemorrhagic type, they were due to blockages of the small arteries.

I had no idea that a gene had been isolated for cerebral SVD. I was about to accuse your doctor of fibbing. It has been quite some time since I studied SVD, and you are probably the first or second person I have read about mentioning it on a forum, and I have been on many different heart disease/stroke forums since 2002. I just did some research and found that there has been a genetic link definitely associated with "Cerebral" SVD only.

I was told in 2003, after having a heart attack and stroke, that if you have SVD in one organ, you most likely have it in the rest of your body. It was proved to be in my brain and heart only. Subsequent MRIs of my brain show that SVD has caused white matter disease. 60% of the brain is white matter, and is mainly involved with transmission or communication with nerves within the body, if I remember correctly.

SVD involves the tiny arterioles. An arteriole is a small diameter blood vessel that extends and branches out from an artery and leads to capillaries. The capillaries lead to the cell tissue then onto the venules to the veins and back to the heart and lungs for more O2.

SVD causes these vessels to become clogged or narrowed, limiting blood supply to the heart, or what ever organ is involved. Atherosclerosis often is a leading cause of SVD. These tiny arteries become diseased. This can affect the microcirculation in the heart, or anywhere it exist.

In order for you to try to remain healthy, do not smoke, do not let high BP go untreated, maintain proper weight and exercise regularly. Have your blood glucose tested to make sure that you are not diabetic. Live a healthy lifestyle and eat right. You might ask your doctor about an aspirin per day. Watch your cholesterol closely. I have given some links that says high homocysteine levels contribute to Cerebral SVD. Another link explains the genetics of Cerebral SVD.

Try not to worry about SVD. There are so many medicines nowadays that can help control and/or prevent this condition.

My best to your Mother and her full recovery,

Jack

Homocysteine is a risk factor for cerebral small vessel disease, acting via endothelial dysfunction.

http://brain.oxfordjournals.org/cgi/content/full/127/1/212

Genetic influences are important in multifactorial cerebral small-vessel disease (SVD) and may act via endothelial dysfunction.

http://stroke.ahajournals.org/cgi/content/full/35/3/654