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Interventional Cardiology (Expert Forum)
At what point does a doctor intervene?
Answered by
Mukesh Garg, MD - Cardiology, Internal Medicine
Truman Medical Center
Kansas City - MO
Questions in the Interventional Cardiology forum are answered by medical professionals affiliated with the Truman Medical Center. Topics covered include acute coronary syndrome, angina, atrial fibrillation, cardiac catheterization, cardiomyopathy, drug abuse & cardiac disease, echocardiography, heart failure, hypertension & heart disease, lipid management, minorities and heart disease, peripheral vascular disease, prevention, valvular heart disease, women’s heart health, and the warning signs of a heart attack.
At what point does a doctor intervene?
by missyc357, Apr 08, 2008 02:37AM
Hi,
I am a 51-year-old female. I had a heart attack at 40, and I've had 3 angioplasties since that included 3 stents in the RCA. Knowing I had heart issues again recently, I made a cardio appointment and opted for the cath lab knowing I probably needed another stent and angioplasty. I did need angioplasty again and 2 more stents. I was a little upset that now my left circumflex is involved, and the doctor seemed very perplexed about the narrowing of my arteries. At what point does a doctor intervene where atherosclerosis is concerned? I expected to feel better after the stents as I did in the past but don't. I feel much the same and maybe worse even. I did have a standing order for outpatient cardiac rehab I found out today when they called and asked if I was interested, so I am going to test my limits there in so far as exercise. I get squeezing at a half mile on my treadmill and am not comfortable exercising at home alone or at a gym. Do you think I should be testing my limits? I honestly think a heart attack will probably be brought on, but what better place to have it I guess, right?
The intervention question is something I've pondered a long time. It seems we just wait for the next MI or near-MI before any action is taken. I do what I can diet wise, I'm on Chantix to quit smoking and trying very hard, I want to exercise but can't and am afraid to now, though I just ordered a brand new spiffy treadmill and got a gym membership. I also am very interesting in heart healthy and cholesterol-related "good" supplements that are on the way and that I paid a lot of money for. I am trying to do my part, but I still feel we are just waiting for another blockage to do who knows what.
I plan to discuss my fears at my FU appointment in a couple weeks, because I am wanting to know "exactly" what my cardio doc is thinking and knows and what I have to look forward to. Why do I feel worse instead of better? Am I headed for bypass?
I am a 51-year-old female. I had a heart attack at 40, and I've had 3 angioplasties since that included 3 stents in the RCA. Knowing I had heart issues again recently, I made a cardio appointment and opted for the cath lab knowing I probably needed another stent and angioplasty. I did need angioplasty again and 2 more stents. I was a little upset that now my left circumflex is involved, and the doctor seemed very perplexed about the narrowing of my arteries. At what point does a doctor intervene where atherosclerosis is concerned? I expected to feel better after the stents as I did in the past but don't. I feel much the same and maybe worse even. I did have a standing order for outpatient cardiac rehab I found out today when they called and asked if I was interested, so I am going to test my limits there in so far as exercise. I get squeezing at a half mile on my treadmill and am not comfortable exercising at home alone or at a gym. Do you think I should be testing my limits? I honestly think a heart attack will probably be brought on, but what better place to have it I guess, right?
The intervention question is something I've pondered a long time. It seems we just wait for the next MI or near-MI before any action is taken. I do what I can diet wise, I'm on Chantix to quit smoking and trying very hard, I want to exercise but can't and am afraid to now, though I just ordered a brand new spiffy treadmill and got a gym membership. I also am very interesting in heart healthy and cholesterol-related "good" supplements that are on the way and that I paid a lot of money for. I am trying to do my part, but I still feel we are just waiting for another blockage to do who knows what.
I plan to discuss my fears at my FU appointment in a couple weeks, because I am wanting to know "exactly" what my cardio doc is thinking and knows and what I have to look forward to. Why do I feel worse instead of better? Am I headed for bypass?
Doctor's Answer
by Mukesh Garg, MD, Apr 09, 2008 10:17AM
, Apr 09, 2008 10:17AM
The problem you are having is a common one in patients with blockages. Stents are very good in providing relief from symptoms but are known to reocclude in some instances. Also atherosclerosis is a progressive disease and can cause new blockages or worsen existing once. Your cardiologist shoul be able to advice appropriate testing and further intervention as needed.
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I thought the same thing when I read your post, lol. (hey, is that my sister?) Speaking of family, heart disease runs rampid in mine, what about yours? I had one cardio doc tell me that no matter what I did, I'd probably never get my cholesterol normal because of the familial aspect--real encouraging eh? My new PCP is determined she says to get it normal (with my help of course), but she's hesitant right now to give me anything that might excite my heart. I took it upon myself to order the supplements. I've read all I can on atherosclerosis, and it seems there is only so much they can say. Exercise is brought up as one of the solutions, and I guess it's encouraging that the heart could eventually perform its own little bypass if I ever get the strength and courage to do the exercise.
Can I ask, Kay, why you were "propped" up? Are you having trouble breathing?
It seems I sometime fear falling asleep and having a heart attack in my sleep. I'm reminded every night of the fact that many have MIs very early in the a.m. by the meds on my nightstand. Do you get that too Kay?
I'm just not coping very well with recovering from this last procedure. I'm not sure exactly why that is, but I'm fearful, anxious, and I feel a mild depression that has been noticed by two health professionals. My PCP commented that she felt "I wasn't stable" yet. I feel "all over the place." I'm kind of a control freak, and I'm feeling very out of control right now. I think the supplements were something I felt kind of gave me back a little control, and I can't wait to receive them for that reason alone.
I just have a lot of issues this time around. Am really looking forward to that followup appointment, and cardiac rehab left a message yesterday for me to call and make an appointment. Hey Kay, stop by my personal site and chat if you ever need to talk, can't sleep, etc., and you want to. http://www.behealthyathome.net Just something I started for networking recently when I decided my focus needed to be my health and not my job. Happy to chat with you, and I hope you are feeling well. I'm sorry you are dealing with much the same as I am, but it's nice to know I'm not alone in what I'm feeling, and it's nice to chat with another female especially. :-)