I really don't know what the proper words or categories are for this question.
Have heard of such a thing, vaguely a year or so ago. Brief history - stress
induced tiny heart attack 1994, angioplasty, angioplasty failure 10 months later,
repeat angioplasty. Symptoms appear late winter 98, meds upped. No history of
high blood level cholesterol or high blood pressure, other blood work usually noraml
no generallized pattern of CAD.
August 1998, angiogram to check on current status, with intent to finally install
a stent, now the usual procedure at this particular heart institute (don't trust angioplasty
anymore so sometime in past three years stopped it as treatment of choice)
Two findings with angiogram that seemed more than a bit surprising to cardiologist
One, the old bad spot is 100% blocked now, solid, not treatable. No blood flow at all.
Too late for a stent.
BUT, as the old bad angioplsty spot was gradually filling, artery had linked up with
smaller blood vessels, and coinciding with blockage formation, increased enough to carry
blood past blockage! Thus, no repeat heartattack, (increased meds to really recuce blood pressure
and nitro patch 4mg may have helped buy time.
How often and common is the occurance of this natural 'bypass'? It has been suggested by
friends and family that I must surely be Someone's Good book!!! :-) And how long can it take for this
new construction to equal the original blood flow?
Sent home with same meds, and told not to go lifting heavy bales of hay anymore!
OH, first heart attack, follwing years of various lengthy stress situations, age 44, and now
stresses over with, more physically active lifestyle (small farm) age just turned 49. And I am
female. (first minor heart attack was preventable, but unstable angina diagnosed as indigestion becaue
doctor did not know difference between men's and women's symptoms and all blood work perfect, normal
blood pressure, normal health, too young, and female - so sent home withorders to take Diovol and
problem would go away. family doctor concurred the next morning. So didn't head back to hospital in time
to stop real attack)
Dear Lesley, thank you for your question. What you describe is the formation of collateral blood vessels to supply the area of the heart muscle that was previously supplied by your own native artery. It is very common for collaterals to form when the regular artery is blocked or severely narrowed. Collaterals can form from the same artery to make a "natural" bypass around the blockage or can form from the contralateral arteries to supply the territory of the artery that is blocked. The heart has some mechanism to form collaterals that we are just beginning to understand. Certain growth factors called angiogenic growth factors are thought to cause collaterals to form when a stimulus of reduced blood supply is noticed. Thus, you have been without severe symptoms now that your own artery is blocked because the collaterals supply blood past the blockage. But, collateral blood supply is never as good as the normal blood supply so your cardiologist has cautioned you to avoid severe exertion. If you only have one artery involved, then medical treatment is most appropriate. If other blockages are present, then bypass surgery may be contemplated. A bypass graft could be inserted around the blockages to your own arteries but angioplasty/stenting cannot be done when the artery has a chronic occulsion. I regret to hear how your initial symptoms were disregarded. You correctly state that woman with coronary disease often has atypical symptoms, which are overlooked. We are trying to increase the awareness of physicians to focus more on coronary disease in women. Also, there is a big study funded by the National Institutes of Health evaluating coronary disease in women. I hope you find this information useful. Information provided in the heart forum is for general purposes only. Your physician can only provide specific diagnoses and therapies.
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