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Collateral veins around blockage

I had triple bypass on 4-23-10. I have always complained that I felt worse after the bypass and experinced shortness of breath and dizziness upon standing. I let my doctor know post surgery, at 6 month checkup and one year checkup. Stress test came back abnormal at 1 year exam. On 8-4-11, I had Catherterization done and found 90% blockage in the OM which was stented. The doctor said I had a full blockage on the RCA just past where the graft was done and that collateral veins had grown around it. He stated that revascuralation of the blockage was not possible. My LVEF is now 40% after the procedure.
I want to ask if a doctor can tell how long the blockage has been there by the size and growth of the collateral veins grown around the blockage. How long do they take to grow??? I have well contolled Type2 diabetes with A1C of 5.9 and tryglycerides are 84. My cholesterol is 180. I have exercised 5 days a week for 30 minutes of cardio exercise. I think my first bypass on the RCA was not successful and it should have been caught at my post surgery exam and six month exam. My doctor wont even look me in the eye and does not answer my questions about my condition. I will seek a new doctor out.
I am very insecure about my health. I just want to live. I follow instructions on low fat diet with exercise and have even lost 50 pounds in the last year.
Am I just peranoid???   How can I find out how long this RCA blockage has been there????
8 Responses
63984 tn?1385437939
Before you had your bypass surgery, did you have a heart cath?  If so, undoubtedly that procedure was recorded and could be compared to the heart cath you recently had.

That being said, blockages can occur very quickly.   This is especially true if someone has diabetes.    I've had blockages occur within two months of a procedure. The fact that you have developed collateral arteries around the blockage is extremely good news, and the fact that you have lost weight, controlled your diabetes and exercise will serve you well.  There are a number of people who post on this site have 100% blocks and collaterals keep them going.  Not everyone can develop them, I can't for whatever reason although I have a similar story of correcting cardiac heath as you.

I'm sorry you have this problem, but it's a bit of an inspirational post.  You have done well.

976897 tn?1379167602
Flycaster is correct in that blockages can form quickly although many people are told they take years. My OM was clear the middle of last year, yet by march I had 2 new blockages in the vessel causing MI. There is no real way to tell how long a blockage has existed, unless there is a history of images (as correctly stated again by flycaster). One other way you can sometimes tell is by when you start to get symptoms. I do believe a blockage of less than 70% will likely not cause symptoms, but at least you can tell when it has gone beyond that size. I felt symptoms in December, and my MI was in March but the symptoms accelerated in severity each week. I would estimate my blockages took around 4-5 months to form.
Collaterals form at the rate they are required, in other words, they will usually begin to open and gradually expand as the blockage forms/grows. The interesting thing is that nearly all collaterals cannot be seen on an angiogram, because they are far too small. I think the smallest vessel visible on an angiogram is around .5mm. The obvious way they can tell is that there's blood on either side of the blockage, so it must be coming from somewhere else. My Left artery (LAD) had a total blockage at the top, and the rest of the vessel was about a third of its normal size, but blood was flowing up instead of down. This was obvious as a collaterally fed vessel.
Thanks to meds, I have very low cholesterol and my BP is fine. What happens with me is that I seem to form blockages during long periods of stressful times.
Your RCA wont affect your LVEF anyway and the LVEF will likely improve over about three months. A 90% blockage is not going to cause necrosis of heart tissue (muscle death). Some of the tissue was likely stunned though. I felt worse after my last 2 stents, for about three months and suddenly I got much more energy and I seem to have no limits now on exertion. One bit of advice I can give you is trust your body. You know how it feels now when something isn't right with your heart and you can trust that. You just have to make Doctors listen, remind them how you was right the last time and they tend to jump into action.
Avatar universal
Thank you  Flycaster305 and ed 34. Your comments are valued and I appreciate you sharing.
I thought I would share the Catherterization recordings. I am unable and not qualified to interpret them.
Internet Explorer 5 or above required to view.
4-21-10 (Before Tripple Bypass)   http://ffury.com/heart/start.htm

8-4-11 (before and after stent in OM)  http://ffury.com/heart1/htm


976897 tn?1379167602
I'm not an expert but I did take a look at your images. I think from looking, before your bypass, you seemed to have a tight blockage mid way down the LAD and the RCA. However, the size of the vessels after the blockage look very large, so they must have been receiving a good collateral feed from somewhere. I'm not sure where they grafted your bypass vessels to, but I'm thinking you had an incident the same as mine. My Left Circumflex developed a blockage in the OM1 and this is the vessel which was giving the collateral feeds to the LAD and the RCA. Of course, when it blocked 99%, it could no longer give that support and the collaterals closed down. I notice how your distal LAD and RCA look much narrower after the stenting suggesting this. However, they will re-open again as your heart recovers. Mine took about 3 months and I felt back to normal.
You will have to keep an eye on that vessel because it's basically doing most of the work and if you get any symptoms, go to a Doctor asap. My OM1 blocked in 2007 and the stent has remained in great shape ever since then. I did form 2 new blockages a bit below that stent due to stressful times which were stented this march.
With so much collateral ability you have a good prognosis.

I assume I looked at the right images for your stenting, the link you posted didn't work so I changed the last /htm to be /start.htm ?
Avatar universal
4-21-10 (Before Tripple Bypass)   http://ffury.com/heart/start.htm

8-4-11 (before and after stent in OM)  http://ffury.com/heart1/start.htm

Avatar universal
I had an 80% blockage in LAD. I had one stent inserted. My EF was 20 to 25% in three months increased to 35 to 40%. I exercise at least 6 times a week and have lost 35 pounds. I am on coreg,lisinopril, aldactone,pllavix and lipitor. I get another echo in 6 months and am hoping the EF will be back to normal. I would just like your thoughts on this happening. I realize it cannot be predicted
976897 tn?1379167602
Well, exercise is not a bad thing if there has been no permanent damage, but too much exercise where necrosis has occurred can accelerate the thickening of walls and mis-shaping of the heart. If you had no damage and your exercise improved EF by 10-15% in 3 months, this is to be expected because the cells take about that amount of time to recover. I should say the majority of cells take that long. The others can take a while longer, maybe 6 months to a year so don't be surprised if the EF has risen more. If not, then the damaged cells have all recovered quite quickly, within the first three months. You do realise that Echo is about the worse measuring tool for EF? I read about research where patients were given a comparison between Echo and Angiogram. The difference in over a quarter of the patients was 10% or more. IF they use contrast injected into you before the echo, then it is 100%. You can guarantee that if you have 4 echo scans on the same day by 4 different operators, you will end up with 2-3 different estimations. From 2007 every single echo has stated 50-55% EF with me, and yet every Angiogram has said 70%. That's a huge difference.
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I have had a knot around my left shoulder blade for about a month. Sometime the pain radiates to my ribs on my side and front. It feels that if someone could put direct pressure on that are I would get relief. Help
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