Advise me

[vram1969]

I am 41 years old male, non smoker, non ethanolic, normotensiveeuglycemic, hypertriglycerimedia (I will take my lipid test after one month). my diagnosis says: Acute inferior Wall MI, Normal LV Systolic EF-65% and i  underwent coronory angio which says : LMCA-Normal; LAD-type 3 and after D1 has 70% stenosis; LCx-Non dominant after Om1 has 100% cutoff, origin has mild atherosclerotic changes OMs are normal; RCA-dominant and mid 20% stenosis; Ramus Intermedius - normal and MY Doc recommended Medical management and now i am takine Clopitab150mgNitrocontin2.6, Rosuvas10mg, Neksium40mg and Ativan 1mg; Doc also planned me to put on TMT (LAD problem) after one month. Please advise me on my condition (severe, OR 50% severe, OR by this medication and change of life style (diet, exercise, etc) lead to normal life).Also i ma planning to follow zero fat diet, physical exercise, Yoga and meditation, etc. Please boost my level of confidence with your encouraging words.

[kenkeith]

The guru related to cholesterol is Jon and I defer any comment to his input on the subject.  I respect his opinion and knowledge on the subject after reading many of his comments over the past 6 years.

You may not be able to reverse the stenosis although there is anecdotal evidence but not scientifically supported studies.  My doctor stated with themedication a higher HDL than LDL can reverse cholesterol buildup. My 72% circumflex cornary artery has been reduced according to a series of tests.  Because there is not truly accurate way to measure occlusion percentage there can be a degree of margin error to explain the difference. However, I have been on nitrates for 6 years and with the medical therapy I am able to tolerate the exertion level without a nitrate currently. A nitrate relaxes cornonary vessels that enables more blood to flow to the hart cells.

QUOTE:All the blood for the heart comes through the left main stem and rca, so if these get diseased then collaterals will never receive a supply to feed any of the heart.

>>>>>>That is incorrect.  There have been a number of posts that I have read over the passed 6 years and many have a collateral bypasss of the LAD.  I have a totally blocked LAD for more than 7 years and obviously due to my heart health there has been a successful bypass. Other people have the same results. Collaterals' may collapse vessels if the totally blocked vessel is reopened due to the gradient pressure of the newly opened vessel is less than the gradient pressure of the collaterals.  Blood will flow through the vessel of least resistance as hemodynamics applies to the physics of fluid dynamics.  

Before ECCP can be effective the result of the phenomonon will be the develpment of collaterals.  My source indicates there is a 70% successful rate, and this has been accepted by insurance actuaries.  But insurance underwriters for medical policies require all other options to be unsuccessful, and your present status should be factored in.  There is no downside as the procedure is non interventional, but the procedure requires 35 sessions...that would be 5X a week for 7 weeks.  If you have the time, you have nothing to lose.  
Thanks for your response, you are welcome to respond if you have any further questions.  Take care.  

[ed34]

Nothing known to science today can reverse the blockages in your coronary arteries or reduce them. This is something which research has been investigating since the human genome was mapped 10 years ago, giving rise to a lot of hope for miracle treatments. However, atherosclerosis has turned out to be a very complicated disease and is not solely developed by genetics alone. If our immune system could be somehow triggered to leave lipids and other cells alone in the artery wall, then we might have a better chance.
There is nothing to stop you from trying EECP, but this is not the miracle cure claimed by many. It does work in a lot of cases, but some people only receive small benefits from this. It also seems to have a time limit with many people where top up treatments are required. All the treatment does is trick the heart into opening tiny blood vessels to help feed oxygenated blood into areas with low supply. It does nothing to the existing disease and the blockages.
Collateral development is still not fully understood and this is why I personally don't like to rely on it. It seems great while they are formed and feeding tissue, but what if they suddenly close down, due to some mechanism we are unaware of. All that extra blood will suddenly be closed off. Maybe when the mechanisms are fully understood, I will have more faith in it, but with EECP treatments having to be repeated, it certainly seems that the collaterals are not a permanent feature. It also doesn't stop the progression of disease which has to be the number one priority. All the blood for the heart comes through the left main stem and rca, so if these get diseased then collaterals will never receive a supply to feed any of the heart. This is why I believe in getting the disease under control first, then having the native arteries fixed. I don't like relying on the unknowns.

[vram1969]

My Chlostral levels are below normal now and my Treadmill test is negative (9 minuts and achieved 94% THR). The only worry is my good chlostral HDL is very low. Doctor gave med. to improve HDL (Omega caps) and alongwith Ecosprin, Flavedon and Aztor. Am i having any risks in the future? What are the steps to improve my heart condition to lead a norml healthy life? Still some times i'm having anginal pains. Please analise my case in detail with your vast experience.
Again i'm asking, can i reduce the stenosis block percentage (reversing the heart disease) in RCA and LAD? shall i take EECP along with medication or not needed?

[kenkeith]

EECP has about a 70% rating for helpfulness related to occluded vessels.  It is claimed by some in the medical field it stimulates collateral vessel development.  My cardiologist stated a recent patient after the several weeks of therapy was able to immediatel play 3 rounds of golf!  The process is usually for patients that aren't successfully treated with medication and and a high risk for a bypass.

With collateral vessels that bypass the oclusion should and will reduce pressure against  the blockade and not with pressure open the occlusion for any stroke, etc.  There should not be any problems with the blockage, but some of the collaterals can close (unlikely) and be spasmatic causing chest pains (can be treated with nitrates if necessary but unlikely to be a problem).  

Thanks for your response.

[vram1969]

Thanks Ken, After the tests(blood and TMT) i will update my status. Meanwhile is there any chance of reducing the 70% (LAD) and 20%of RCA stenosis?(for example, following zero oil diet, exercise, EECP, Yoga for Heart, Meditation and Medication) and my doctor is not recommending any intervention at this time because, considering the locations of the blocks.
Another question is, What is the future course of 100% blockage? is it stable at that place lifelong? or any chance of clot burst making the vessel damage  or other unwanted incidents happen? (i'm afraid of the things - stroke, heart failure, etc). Please throw some light on this.

[kenkeith]

Ed has made good suggestions and some analysis, but I will provide another perspective.

You are correct your totally blockage can be adequately provided blood/oxygen and no need for intervention.  In fact there is some evidence of circulation problems with opening a totally occluded vessel.  Also, to considered is that the LCx is a branch and non-dominant, and RCA is dominate and that can feed into the deficit area of blood supply from the LCx. Everyone has an unique configuration of arteries and vessels so it is difficult to assess without that knowledge...the best test would be a vessel by vessel comparison with computed tomography coronary angiography (CTCA).  You have had an angiogram so there may be some knowledge of your vessel geography.

Your other vessels don't appear to have a need to stent.  I have had a totally occluded LAD (important vessel) and collaterals seem to be sufficient for the past 7 years or more, and the occluded 70% circumflex has been occluded for the past 7 years or more.  Exercise and medication has stopped and adequately controlled any further lesions.

Thanks for the followup questions and if you have any other questions, you are welcome to respond.  I wish you well going forward.
Regards,
Ken

[vram1969]

Dear Mr Kenkeith, Can you please assess my case and advice me:
1. Is my case is severe / moderate / mild
2. Is it be manageable by medication?
3. Next week i'm going for TMT and my LIPID tests after takeing 1.5 months medication.
4. I am now on good heart diet, 30 mts of walk everyday an to follow all the options for meaking me a quality of life.
5. I want to know my 100% occulsion can be resolved by the collaterals (41years old)
6. Is any intervention (plasty or stent ) is required for my case?
7. With diet, medication, exercise (walk, yoga) can i reduced the 100%, 70% 20% bloackages in all 3 arteries (not in mains)?
Please reply me.

[ed34]

I think in your position I would want a nuclear scan done. It's just my opinion and what I would be asking for. Although you have collateral development for the bottom of the Circumflex, is it enough? It could be the Circumflex causing your symptoms and not the LAD, so I would want them to be certain. With only a couple of blockages, and such a good EF @65%, I think it's worth the intervention of a stent or two if it means a normal quality of life. Your heart tissue sounds to be in great shape.

[vram1969]

Helo ED34, Thanks for your response. I have the MI on 01.09.10 with less symptoms around 2am and the pain went off around 4AM. In the morning i took the ECG and it shows possible inferolateral ischemia and 2 days later i consulted my Cardiologist and further tests(Blood test- S.creatinine 1mg.dl, ECG-showed sinus rhythm small Q in lead iii,Chest Xray-Ct ratio50% increased brochovascular markings, Echocardiogram: (LMCA-Normal; LAD-type 3 and after D1 has 70% stenosis; LCx-Non dominant after Om1 has 100% cutoff, origin has mild atherosclerotic changes OMs are normal; RCA-dominant and mid 20% stenosis; Ramus Intermedius - normal) were taken. No intervention of arteries were made at the time of angiography. The 100% of LCx was on my first MI on 01.09.10. My doc says that 100% block was compensated by the Collaterals (or other arteries), thats why i have survived during MI and now he is looking for this 70% steno on LAD type iii vessel and it is at after D1. As per Docs advise i am going for TMT after 15 days. I want to know my condition whether i can lead a normal life after the TMT tests and what type of Scenarios of the outcome of the TMT? Now i am walking moderately 1.5 kms daily with less (manageable) pain.

[ed34]

Before commenting, do you have any more info on the acute MI? How long ago was this and did they stent any vessels to get blood to the tissue? If they didn't do any intervention, I am surprised at your normal left ventricle function and brilliant LVEF @ 65%.