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Avatar universal

If EECP is ineffective after 35 sessions...

I have completed 27 of 35 1-hour EECP sessions and have yet to see any improvements. I still get chest pain from climbing 3 flights of stairs. If there is no improvement after 35 sessions, should I try for another 35 or move on to invasive alternatives. I am currently treated with metaprolol, lisinopril, and atovastatin for my atherosclerosis from 3 very blocked arteries. I am on a plant-based diet as detailed in Dr. Esselstyn's book. I am on 3g L'arginine and 200mg zinc with copper. Omega-3 3g. Vitamin Ds, Es, B-12, the works. My total cholesterol is 79, triglycerine 113.

Anyone here with similarly disappointing EECP experience?
18 Responses
63984 tn?1385437939
I'm jumping in on your question to Ed34, I have some personal experience with this.  
When my first stress tests hinted at blockages, I asked that no stents be inserted, but wanted balloon therapy, and three 70% blockages were so treated.  Continued angina led to a second angiogram about six months later and stents were inserted.  I was prescribed 81mg aspirin and Plavix.
in subsequent years I developed new blockages in different places, but for the last 13 years all my stents are patent, e.g., open and unobstructed.  I have found 81mg aspirin far more invasive than Plavix.
I requested several time to be taken off Plavix, and each time I developed blockages to native arteries and finally to grafted veins.  I've made a lot of mistakes in my life, but one of the biggest mistakes was to fear and ask that Plavix be discontinued.  
As to your question about angina, where the blockages occur have to be part of the conversation.  I've had almost total blockages with no angina, and have had strong angina in areas only 70% blocked.  
The big fear one should have taking Plavix and certainly 81 aspirin is what will happen if you need emergency surgery.  I experienced that with a bowel obstruction, but they prepared for it during my surgery and it went well.  If one takes Plavix and/or aspirin it would be wise to wear a warning.

We are all different, but from my experience, I had restenosis quickly after balloon therapy, have never had restenosis in stents, and have eight.  I've paid a heavy price with new blockages after refusing Plavix.  Angina differs where the blockages are, believe me.
Avatar universal
EECP is a first step approach as it is non-invasive. I typically see that results are at 50/50 odds for a positive result, but still worth trying first . You might as well finish your sessions, but don't be disappointed if it does not work.  Think of this as part of the process of least risk/cost until you find a solution that works for you.  

I noticed that you did not include your current blood pressure which would be helpful in my response to you.  Also, do you have any "heart rate" issues or just high blood pressure and/or angina.  The reason I ask is that one of your meds is a Beta Blocker which some doctors use for angina, but there are far better choices that will not effect your exercise stamina (which metaprolol is known for).  If you do not have marked arrhythmia's as part of your heart issues I would ask your doctor about trying a different anti-angina medication such as Diltiazem as it works great for angina without the side effects you mention that you are having.    

I hope this helps
1756321 tn?1547095325
"All statin drugs (HMG-CoA reductase inhibitors) block the biosynthesis of both cholesterol and CoQ10, which explains their common side effects of fatigue, muscle pain, and a worsening of heart failure.

When CoQ10 levels are lowered by statin drug therapy, one of the first changes to occur is a weakening of heart muscle function, known as diastolic dysfunction. This has nothing to do with diastolic blood pressure, but rather represents impairment in the relaxing or filling phase of the cardiac cycle. After heart muscle contracts, it takes a great deal of cellular energy, or ATP, to re-establish the calcium gradients such that muscle fibers may relax. Thus, if diastolic dysfunction is severe, it can result in congestive heart failure."

"Atherosclerosis remains a disease of unknown cause. Many factors more important than cholesterol—such as stress, smoking, hypertension, insulin resistance, high triglycerides, diabetes, and low testosterone (in men)—contribute to atherosclerosis and cardiovascular disease.17-19 Despite this, the theory that cholesterol is the dominant villain responsible for atherosclerosis has been promulgated for over 60 years, making the pharmaceutical industry’s anti-cholesterol campaign the most profitable medical myth of all time.

Statin drugs do show some benefit in reducing mortality in individuals with pre-existing coronary artery disease.20 This benefit occurs irrespective of cholesterol lowering and is likely secondary to their subtle anti-inflammatory or plaque-stabilizing effects.21 The vilification of cholesterol and the associated aggressive lowering of cholesterol blood levels has brought about increasingly severe CoQ10 deficiency in a large number of patients, making it absolutely critical to restore CoQ10 levels in these individuals."

Life Extension - Alleviating Congestive Heart Failure with Coenzyme Q10

976897 tn?1379167602
EECP is still in its infancy, and in reality it isn't really understood how it works. It is assumed that increasing pressure in the coronary artery system forces them to open. You can imagine however that with a huge variety of circumstances across patients, with varying blockages and distances involved to healthier supplies, that it will not produce the same impact. Collaterals have to be fed by a vessel with a fairly good flow and pressure. If two vessels are diseased then I can't see much happening?
Avatar universal
I dont't have the blockages that you mentioned - at least I think I don't - but I had shortness of breath from Metoprolol alone (as mklarson mentioned) and couldn't even walk up small inclines without having to stop on top of the hill to catch my breath. I am glad I got rid of it and now am on Lisinopril only.
Avatar universal
I forgot: did you ever try the "Swallow Cliffs" in Palos to test your endurance? I can only make it 3/4 up, I am sorry to say, and I have seen people do it 25 times in a row.
Avatar universal
Thank you all for your helpful comments. I will be completing my 35th EECP session tomorrow and I have not seen any improvements. I will look into taking CoQ10 supplements. A few more bits of info about my condition: my BP is on average 110/75 but had dropped to 100/70 quite often around nighttime. My stamina remain the same (low stamina) regardless of medication. I wanted to get angioplasty without stents but my cardiologist would not consider doing it without stent placement. The idea of taking Plavix for indefinite duration or risk late stent thrombosis plus bleeding risk scared me away from stents; otherwise, it would have been my choice of treatment. Angioplasty without stents has a restenosis rate of 30% which is much worse than DES but I see the positives --- no Plavix and 70% without restenosis.
63984 tn?1385437939
I agree totally with Ed regarding the development of collaterals, it takes two healthy vessels to develop them.  My story is long, but I have my LAD below the first diagonal that has some blood flow, but my RCA has almost none, this is after a failed bypass. Without two healthy vessels, from what I understand, there is no chance of developing collaterals.  I hope I'm wrong, I'd jump on EECP if so. I wish so much I could have more stents inserted, but it isn't possible.  I'd suggest you re-visit your views and options.  
CoQ10 is a very difficult drug to accepted by the body, according to a very close relative who was part of the research in the Midwest during the 1950's when it was discovered as a natural-occurring product, like cordisone.  Both were considered wonder drugs, but problems with introducing it, whether by pill form or injection, made it problematic.

I'd think you would be wise to consider an angiogram to see what is happening to your heart, and agree to a stent if possible.  I'm betting it would change your life.  I've extended my life for 16 years by getting stents and taking Plavix, I was 59 years old when I started, and I'm still standing.
976897 tn?1379167602
If stents really worry you, has your cardiologist mentioned biodegradable ones? Personally, I have been on plavix twice now, each period for 18 months. Never have I developed clots from being withdrawn from the medication. I can't help but wonder if this has to do with a patients own natural clotting factor.
Avatar universal
I am pretty sure the biodegradable ones are not available in the US yet. But when they become available and proven effective, it's a game changer. I will definitely go for it when they become available.
976897 tn?1379167602
What worries me is that the stents need to keep a collection of fat etc in the artery wall. If they degrade to nothing, then the material is just going to bulge the artery into the lumen again.
Avatar universal
The key is severity of blockage. If the artery is blocked again due to restenosis but not as blocked as before angioplasty then it's an improvement. My guess is that the severity of blockage is proportional to the severity of angina. I have been unable to find info about the severity of blockage due to restenosis following angioplasty without stents. Is the amount of blockage the same or less after restenosis when compare to before angioplasty?
976897 tn?1379167602
With regards to ballooning and stenting. We need to look at a little bit of history here. First came ballooning, which simply inflated a tiny balloon and forced the artery open. They found that 70 % or more were simply collapsing again in a short period of time. They also found that many arteries were growing excessive amounts of scar tissue, blocking the artery even more than originally. Then came the bare metal stent. This improved matters because the artery couldn't collapse again, BUT scar tissue was still a huge problem. Then came the Drug Eluting Stent. Coated with a chemical to inhibit scar tissue growth, this seemed to improve matters, but not as much as originally hoped. Imagine you have a very large wall, and some 2 inch netting. You dip the netting into paint, and stick it briefly to the wall. When you remove the netting, most of the wall will be unpainted. This is what happens with Drug Eluting Stents, being a MESH they only deliver the drug to around 1-2% of the artery lining. The remainder is not inhibited against forming scar tissue. Now the latest development, the Drug Eluting Balloon. This guy is brilliant in its simplicity. The actual balloon is coated with the chemical, as well as the stent and when inflated, over 98% of the artery lining is coated because the artery conforms to the shape of the balloon. It can actually be used in arteries too small for stents, and has shown very good results so far.
Avatar universal
The ideal solution would be biodegradable stent with drug eluting balloons. I don't think either ones are FDA approved for coronary angioplasty in the states.  I just have to wait for the day when both become widely available.  
976897 tn?1379167602
but with ballooning and biodegradable stents, what happens with all the fat trapped in the artery wall? Surely the pressure will gradually bulge the artery inwards again as the dissolving stent loses its strength? I can see biodegradable stents having more specific uses, such as in small arteries or those in the brain perhaps. For the larger coronary arteries I just don't see how they would cause long term benefits.
Avatar universal
Where have you been all my life.  I have congestive heart failure.  After my last echo (EF 25-30%) my doc started me back on lopressor.  I had quit it previously due to depression.  In the mean time I have been taking Ubiquinol 100 mg twice a day.  Some time last week I ran out.  So last Friday a bought of depression and fatigue hit me like a ton of bricks.  After thinking about what may have caused it, I decided to quit the lopressor.  Then I stumbled on a post about depression and CO Q10.  So I ran out and bought some right away.  Feeling better but not as good as I had been before the lopressor.  Thanks for your post.
1756321 tn?1547095325
I've been in a little place called Australia lol. So glad you are feeling better than before. You might want to also try Pycnogenol, French Maritime Pine Bark Extract. :)

Coenzyme Q10 and Pycnogenol® Help in Heart Failure Patients...

"Coenzyme Q10 (CoQ10), a vitamin-like substance involved in energy production, can help strengthen a weak heart. A new study has found that a combination of CoQ10 and Pycnogenol®, an antioxidant extract of French maritime pine trees, also benefits people with moderate to serious heart failure.

Gianni Belcaro, MD, PhD, of Chieti-Pescara University, Italy, and his colleagues treated patients with either the CoQ10 and Pycnogenol® combination or placebos. All of the patients were also treated according to conventional medical guidelines. However, people taking statins were excluded from the study because the drugs reduce CoQ10 activity.

Thirty-two people took 350 mg of CoQ10 and 105 mg of Pycnogenol® daily, while 21 people took placebos for 12 weeks.

The supplement combination led to significant improvements in heart function, whereas the placebos did not. On average, people taking CoQ10 and Pycnogenol® had a 22 percent increase in ejection fraction, a measure of the heart’s ability to pump blood. They also had significant decreases in blood pressure and edema, and they were able to walk more than three times farther on a treadmill.

Nine of the 32 people taking CoQ10 and Pycnogenol® had an improvement in their New York Heart Association (NYHA) classification of heart failure, compared with only three of those taking placebos. NYHA heart failure classifications are used worldwide to assess the severity of heart failure.

Reference: Belcaro G, Cesarone MR, Dugall M, et al. Investigation of Pycnogenol® in combination with coenzyme Q10 in heart failure patients (NYGA II/III). Panminerva Medica, 2010; 52 (Suppl 1 and 2):21-25."
159619 tn?1538180937
Please see your doctor and discuss any new supplements before you start, especially given your condition. None of us are medical professionals and no one here are qualified to give medical advice and that includes supplement use.
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