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triple vessel disease
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triple vessel disease

Hi,
  A case where the angiogram reveals stenosis in LAD ranging from 90-99 %; OM1 total occlusion in distal segment, OM2 diffusely diseased throughout its length; and RCA minor irregularities throughout and PDA has stenosis from 70 - 90%.

The final diagnosis states

Triple vessel disease
Coronary Disease
Old Anterior Wall MI
LV Dysfunction
Aorto Iliac Occlusive Disease

The DOC has advised medical treatment containing Clopidogrel and asprin.
CAG has been ruled out!!!!
??????
Is this sufficient or some other method is there to bring down the stenosis.
Kindly help with valuable Suggestions/Guidance
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Avatar_n_tn
sktvm,

Thanks for your Yoda-like question. Help you I hope I can.

The current medical standard of care for most people with the above diagnoses would include:
aspirin,
beta-blocker,
ace-inhibitor,
statin,
+/- clopidogrel
+/- nitrates.Other medicines would depend on the particulars.  Even the above medications would not be given to everyone.

The real question that needs to be addressed is why was heart surgery "ruled out".  We find that we offer surgery to patients at the CCF that were refused at other locations.  Seeking a second opinion at a major academic medical center near you, or here at CCF, never hurts.

May the force be with you.


10 Comments
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Avatar_n_tn
Nice to hear with a sense of humor a doctor it is.
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Avatar_n_tn
In a way you are lucky that you are not a candidate for bypass surgery.

As fantastic as it seems, you may be able to return yourself to reasonably good coronary health with a combination of aggressive lipid therapy and daily exercise.

I have three vessel disease with a 100% occluded RCA.  I brought my cholesterol down from 240 to 110 with a combination of Lipitor+Niaspan+Welchol.

I walk 30 minutes before work and 30 minutes before lunch during the week.  My circuit has some hills in it to get the heart working a bit.

On the weekends I do something more strenous.  Things have gotten better over the last few years.  Yesterday I walked 10 miles in the mountains and up and down about 2000 feet.  Today I walked about 5 miles.

I eat a lower fat diet, but still eat pretty normally.

I control my blood pressure with an ace inhibitor and calcium channel blocker.

I take a good multi-vitamin, Vit E, Folic Acid, and a few other supplements.

Although Plavix may lower the risk of an immediate heart attack, once you get your LDL real low, the risk of a plaque rupture will be greatly diminished.

I don't use any blood thinners, nitrates, or beta blockers although they may be necessary for sedentary patients.



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Avatar_n_tn
Hi!
I have a ? for you! My lipids arent so good either - my HDL needs to come up dramatically. Is that why you were on the niacin drug? Did that give you any side effects? I always though, NIACIN = FLUSHING would = PVCs up the ying yang! So I have been afraid to try it. I heard it is one of the only things to really bring it up. My LDL isnt SO bad at 150, but definately needs to be lower - my HDL is only 30 - which Definately needs to be higher - do u think they would recommend taking a lipid lowering drug (statin) along WITH the niacin ? Do you have to take them for the rest of your life or once lowered , can I get off and see how things go?  Cant the Niacin be bad for your liver over time?  Sorry for so many questions - when I do research I get answers on BOTH sides - its nice to be able to talk to someone who actually HAS taken them. Most Drs havent been through it.  Thanks!
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Avatar_n_tn
Because of my severe coronary condition, I have been trying to get my numbers very low and my HDL as high as possible in the hopes of arresting the disease and perhap reversing it over time.

Studies at the University of Washington have proven that a Statin + Niacin can stop CAD in it's tracks and reverse it over 5 or so years.

I think that there are only three things that will raise HDL: exercise, alcohol, and large doses of Niacin.

Niaspan can raise your HDL significantly and also lower LDL and total cholesterol.  Several weeks after I started it my total cholesterol was 158 and my HDL had increased from 37 to 48.  I was expecting TC in the same range this year and perhaps a little better HDL.  I was surprised that my TC was 110, LDL only 50, and HDL was 37.  Although the HDL was lower, the ratio was tremendous.  I couldn't believe these numbers for someone who is 210 lbs and eats a fairly normal diet, so I had them run them on another machine.  Almost identical results.

I haven't had problems with the Lipitor+Welchol+Niaspan combo and my liver enzymes remain normal.  I take all of my cholesterol meds including the whole 1500 mg of Niaspan at bedtime.  I have had only a few episodes of flushing when I ate or drank too much at bedtime, but otherwise no problems.

Although I have had PVCs the year after my heart attack, my heart has been steady as a rock for the last 2 years.  I don't know if Niacin aggrevates rythm problems, but I haven't experienced it.

I plan on remaining on the triple drug cocktail for another year and then perhaps backing off a little - perhaps dropping the Welchol.

Because these drugs are relatively new, I don't believe knowledge is wide spread as to how effective they can really be in combination.  Most doctors are way behind the curve.

I believe that you can halt and possibly regress your coronary artery disease without stents or bypass with this kind of aggressive cholesterol therapy, exercise, and lifestyle changes.




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Avatar_n_tn
Thank you SO much for your help! I am 37, but with my family history , and my pvcs and my HDL being icky - I am headed for trouble.  Did you go through a cardiologist for all of this or just your intern? My intern doesnt seem to have a clue when it comes to all of this - I was THRILLED that you mentioned you can actually reverse CAD!! I had heard things, but they said "well maybe, " and "not much reversal" - but Ive never read about drugs helping it along. Makes sense though! Clean out your arteries with HDL to get rid of what is already there. Thank you SOOO much!  I will follow up with this right away.  You have been a huge help!  good luck on getting your 20 year old heart back! Do u think exercise really raises HDL all that much? My dr said MAYBE 10 points max.
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Avatar_n_tn
You don't really have to reverse coronary artery disease to get back to a normal physical life.  It's not the blockages that kill you - it's plaque ruptures followed by a clot completely blocking a vital artery.  How many times have you heard of someone, who people thought was in great health, dropping dead from a heart attack.  That's a plaque rupture - it happens to healthy people every day.

You can have a very vital physical life with multiple 90% blockages and maintain a low risk for cardiac events or sudden death.  It requires aggressive lipid and BP therapy, exercise, and lifestyle and attitude changes.

Statin drugs help in many ways, only some of which are understood.  They reduce LDL but also reduce inflamation (inflammation), which may be more important.  I believe that they dry up the lipid pools in the coronary arteries, drasticly reducing the likelyhood of a plaque rupture.

As your internist stated, exercise will only raise HDL about 10%.  But exercise helps your system in so many other ways and daily exercise is necessary to maintain coronary health and tone.

Niacin is the only drug proven to raise HDL significantly.  It may also benefit in other ways that are currently not well understood.  Niaspan is a good way to take high doses of niacin without flushing.  If you have insurance, the copay is less than buying that much over the counter niacin anyway.

In the future there will probably be a vaccine or gene therapy to correct familial HDL deficiency, but currently niacin is your best bet.

I arrived at my cholesterol and BP cocktail of drugs by a variety of study and asking for and trying certain drugs.  I also discontinued some drugs that had been prescibed early after my heart attack.

I believe that there are certain drugs that people who want to return to normal health shoudn't take.  For me that includes blood thinners, nitrates, and beta blockers, although these drugs may be appropriate for other people.

I take responsibility for the drugs that I am on and believe that they are currently the best possible cocktail of drugs for my condition.  I think that is half of the battle.

The bottom line is that I lead a normal life with good physical ability even though I have had serious 3 vessel coronary artery disease.  I do have hope of completely reversing that disease process over a period of years and renewing my arteries, but in the meantime will settle for managing it as a chronic condition rather than opting for bypass surgery.





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Avatar_n_tn
Thanks so much for your post! You know I am going to ask my dr about these things. I also would like to get pregnant and I dont want to be on beta blockers while pregnant - but I cant stand the pvcs cuz mine tend to be intense too so Ill see.

Do you think beta blockers prevent getting back to a normal lifestyle? IS that because it sort of puts a damper on everything and doesnt let your body reach its full potential/ ie; lower heart rate etc?  Have you been on them before? I know they said you have to wean off slowly - but the method the pharm told me about instigated bad pvcs when I tried his method - Id like to try something a bit slower!

I am definately going to check out the niacin / I just hope it doesnt cause more pvcs! Or without the niacin, maybe get my LDL and tris so low it wont matter? hmmmmmm

your right - everyone is different, and we have to be gineau pigs until we figure out whats right for us. THanks for the advice!
Sheila
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Avatar_n_tn
If you have PVCs, a beta blocker may be the best or only choice.

I had PVCs for several month's in the year after my heart attack and I know how disconcerting they can be.  Fortunately I transited through them.  Perhaps it was the daily walking.  I also think Altace helped although it's not indicated for that.

Beta Blockers are automatically indicated for people who have heart attacks, whether they have rythm problems or not.  This may be good, but when I started progressing to more stenous exercise, they became counterproductive.

I also suffered episodes of near syncope which stopped after I quit atenolol.  It took several weeks after quiting for my heart to be normal when I exercised stenously.

Anyway, Atenolol was ok for me at first, but it just didn't work as I became more physically active.

Best Regards
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Avatar_n_tn
Thanks again so much for your help!
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