Aa
Blocked RCA
A friend of mine went for an Angiogram after he complained of some (mild) Angina. The report said, among other things, that they spent almost three hours to stent the Right (acute) Marginal way at the bottom, but weren't successful. He has two stents already in the RCA, one in the Mid-RCA, the second below it. Obviously, the Marginal is a lot smaller in diameter than the RCA, so a smaller stent can be used. But a) is it even possible to feed that stent through two existing ones and b) is it even necessary since the artery is so small and being way down to have much of an effect?
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As far as I am aware, the right side of the heart has an easier job than the left side. The left side has the job of pushing blood to all the body tissue, while the right side only has the job of pushing blood through the lungs. I believe the right side can suffer a MI without complications, but the left side is far more likely to suffer complications such as angina etc. Ablations, can cause even more issues. When I complained to my cardiologist of angina a few years ago, he suggested I have ablation to destroy the cells causing the pain. My big question was "How do I know when there is a problem with my heart when there are no symptoms? I could start running and end up wrecking my heart". He kind of laughed and then said "no we will forget ablation". Ablation in my opinion should only be used for sorting out electrical signals on the heart, the keep it in rhythm. My RCA is blocked just above the 1st marginal, but over time I have opened up a whole bunch of collateral vessels. When you look at my angiogram, blood goes around the blockage through 2 different new vessels. My LAD is blocked from top to bottom now, but the left circumflex is feeding across to all those areas. I had a new echo last week showing normal heart dimensions and an EF of 70%. However, on moderate exertion I do get leg pains and shortness of breath followed by a killer throat discomfort. So at rest my heart is great but above that it suffers. The actual method for atherosclerosis is still not fully understood, but there are many theories. I believe in 10 years or less, there will be a cure. I didn't think there was a way to remove the clot material in the artery wall, but there is. It takes HDL cholesterol to do this but the macrophages must have the correct coding on them. They remove the fatty material from many people, where the macrophages signal the HDL to come get the fats. In people like me, the macrophages don't seem to signal the HDL correctly to the fat stays there. I think in the next ten years a medication will be available which will signal HDL to pick up all the fat, opening up the arteries again. This would even work through existing stents.
You're welcome. It's the same with me, if I get a blockage form in my LCx, I feel a very bad throat discomfort. When my LAD was blocking, I had chest pains. I'm not saying the pain is actually in the heart, but it certainly causes it.
To Ger57: Yes, that's what his cardiologist suggested: use a Nitro-patch. He doesn't want to do it because of all the side effects and he is taking Metoprolol and Lisinopril already.
To ed34: Me personally I am more with you, but I don't know what the effect of the Right Marginal completely closing would have on his heart. And closing it will eventually, I am sure. He had a triple bypass 13 years ago because of blockage of the LAD just below the D1 and it's still working and besides the two stents in the RCA he had another one put in the Circumflex which they told him is now completely blocked and that he had developed collaterals to make up for the lost flow of blood. But these are not his only problems: several years ago he had ablations - two, I think - done and he now has a full time pacemaker because they screwed up the ablation - at least that's what I think at this point due to lack of more information proving me wrong..
To ed34: Me personally I am more with you, but I don't know what the effect of the Right Marginal completely closing would have on his heart. And closing it will eventually, I am sure. He had a triple bypass 13 years ago because of blockage of the LAD just below the D1 and it's still working and besides the two stents in the RCA he had another one put in the Circumflex which they told him is now completely blocked and that he had developed collaterals to make up for the lost flow of blood. But these are not his only problems: several years ago he had ablations - two, I think - done and he now has a full time pacemaker because they screwed up the ablation - at least that's what I think at this point due to lack of more information proving me wrong..
Hi Ed,
what you just wrote is completely new to me (angina coming from left side of heart). I always thought that the heart itself can not send pain signals to the brain and that it actually is the surrounding tissues that do that. That is the reason the the pain is often very diffuse and that it is hard to point the exact point of origin.
When I think back of my experiences with coronary stenoses:
When I had a severe blockage in my LAD, I experienced mainly angina. When I was treated for blockages in my RCA, I experienced mainly shortness of breath and loss of exercising ability.
So yes, the symptoms I experienced were quite different, comparing left and right heart problems.
I always wondered why symptoms were so different, but thinking of it, it just makes good sense. If my shin bone hurts it also will feel different when the pain is close to the knee or close to the ankle.
Thanks for sharing this.
Ger
what you just wrote is completely new to me (angina coming from left side of heart). I always thought that the heart itself can not send pain signals to the brain and that it actually is the surrounding tissues that do that. That is the reason the the pain is often very diffuse and that it is hard to point the exact point of origin.
When I think back of my experiences with coronary stenoses:
When I had a severe blockage in my LAD, I experienced mainly angina. When I was treated for blockages in my RCA, I experienced mainly shortness of breath and loss of exercising ability.
So yes, the symptoms I experienced were quite different, comparing left and right heart problems.
I always wondered why symptoms were so different, but thinking of it, it just makes good sense. If my shin bone hurts it also will feel different when the pain is close to the knee or close to the ankle.
Thanks for sharing this.
Ger
I thought angina was brought on by the left side of the heart? Is there a chance they are fighting a red herring? When they do an angiogram, get them to perform FFR on all the main arteries. This tiny sensor will tell them if there is any drop of in blood flow. A few years ago I went to hospital with chest pain and an angiogram showed no new problems. When I asked the cardiologist to perform FFR he said good idea and went ahead. My left circumflex was a beautiful vessel on the screen, full of blood but the FFR showed an 80% drop in blood flow half way down. He had to put 2 stents into the vessel to make it normal and it took my pain away instantly. Things are not always as they seem. A cardiac surgeon told me 7 years ago that the left side of the heart causes angina and my cardiologist has since said that too.
yes it is possible to place a stent by going through a stent with larger diameter. If a stent is deployed, its diameter is much larger than when it is inside the catheter before being deployed.
If they can not place the stent, they could try balloon angioplasty (only stretching the vessel without placing a stent), but they will have considered that already I guess.
Then there is the option to treat with vasodilating medicine like they do with coronary microvessel disease.
If they don't treat it, there is of course the chance that your friend will suffer a (smaller) infarction.
It could however also happen that new vessels will grow as a natural response of the body to the ischemia, that will act as a bypass for the blocked vessel.
Good luck to your friend.
Let us know what was decided.
If they can not place the stent, they could try balloon angioplasty (only stretching the vessel without placing a stent), but they will have considered that already I guess.
Then there is the option to treat with vasodilating medicine like they do with coronary microvessel disease.
If they don't treat it, there is of course the chance that your friend will suffer a (smaller) infarction.
It could however also happen that new vessels will grow as a natural response of the body to the ischemia, that will act as a bypass for the blocked vessel.
Good luck to your friend.
Let us know what was decided.
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