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What is ‘Medium-sized inferoseptal infarction with minimal peri-infarct ischemia’?

The above Lexiscan report mentioned a LV ejection fraction of 71%

I’d like to tell about my history, but only to the extent you wish to know, so I’ve arranged this in time blocks. If you want to skip the life history, just jump to the ‘last twelve months’ near the end.

History: I’m male, 75, 5’8” and muscular 175 lbs, played full scholarship NCAA Div One football, and graduated at Harvard and Stanford, I quit smoking at age 35, and have always been  immoderate with alcohol, I’ve played tennis three times weekly until two years ago when my wife of 50 years died suddenly, a year of depression and heavy drinking ensued, then I quit alcohol forever with no physical withdrawal symptoms and found a great psychiatrist. I’ve had HBP in the range of 135/85 for most of my life.

Last twenty years: in 1998, a screening kiosk at Vanderbilt reported my heart calcification at the 99th percentile. I found a cardiologist and she controlled the BP then above 145 and Lipitor 40 mg, and over two years ordered a stress ecg, and thallium stress echo, all normal. My total cholesterol was 230 and the statin brought my LDL to less than 60 and HDL over 40 with low triglycerides. This has been stable since my first Lipitor dose. We moved and I changed cardiologists over time and have had angiograms heart caths four times. The main descending artery was blocked in two places by 60% and two other arteries were blocked 40%. There were no stents the that could span both stenoses. No apparent change has occurred in blockage since the first angiogram.

Last four years: as my base BO is above 155, my drugs have escalated accordingly with carvedilol, losartan, and Norvasc; Four years ago breath shortness led to the placement of a long stent that could span both stenoses in the big artery. Three years ago I was hospitalized for three days with CHF with asymptomatic afib and went on 20 mg Lasix and Pradaxa, blame pointed to the afib and water overconsumption.

The last twelve months: have had severe iron deficiency anemia with hemoglobin dropping from 13+ to a low of 9.2 at that time I suffered two more CHFs, I’m now taking iron and 40 mg Lasix daily, after iron therapy, hemoglobin recovered to 13.7, recently: echo cardiogram during worst of anemia reported ‘diastolic failure’, heart MRI showed thick inelastic ventricular walls, and reduced refilling of ventricles. The anemia started a search for a ‘bleed’. GI doctors found no stomach or large bowel bleeds, next is intestinal scan. The recent Lexiscan stress echo report was to further evaluate my cardiac condition. I feel good, and my emotional state is upbeat. Our sons are independent, successful, super educated, and making offspring.

If this heart condition is unfailingly progressive, I’d like to know. And I’d like to start exercising again, if only to be able to have a normal stress echo, but I’m wondering how much, and if it’s dangerous. The last two CHF stints were two weeks apart, as I the first went away before my upcoming cardio appointment. The last one I feared for my life, struggling for each breath. I do not want to die under conditions having such anxiety.
2 Responses
20748650 tn?1521032211
Yes its progressive.. Reversal of the afib will help, as can reopening some vessels that maybe arent totally occluded, or vessels that are fed by strong collaterals (new arteries that grow in an attempt to replace the ones that are blocked).

Some patients in heart failure types of situations also benefit from the implantation of biventricular pacemakers. The pacemaker often helps restore some of the "organization" thats lost. This is of principle benefit to patients with systolic heart failure. However i mention it because the terms systolic and diastolic heart failure are a little misleading, systolic and diastolic function are very interdependent on one another, and i doubt a patient with your history hasn't lost at least some degree of ventricular synchrony.

Ill touch on your prognosis later.

The nonsense they fed you about not having stents long enough is bull.. Even in 1998.. I dont know who told you that but obviously if the lesion is too big you can just put multiple stents, each overlapping the other and make a whole stent.

We have the capacity to, and reguarly practice the implantation of full metal jackets that span the entire artery.

There is a limit as to how many stents we can place, but thats why people get bypass surgery.

Fractional flow of 80% or less is indication for a stent, so with 60% and 40% flow you should have beeb stented or operated on.

As for the title, the septal infarct with minimal peri infarct ischemia means.. The blood flow was cut off to that part of your muscle that is directly fed by the occluded artery is shot... But the nuscle that surrounds it is still receiving adequate blood flow from other areas.

Unfortunately none of the information provided gives any insight into how viable the muscle is, or any benefit that you may receive from having any chronically occluded vessels opened. Also of concern here is the fact that the septal arteries are of a very small diameter..

Length of stenosis isnt necessarily a factor for what we can do, but diameter of the vessel certainly impacts what tools we can use to fix the problem.

Theres also the possibility of "no reflow stenosis" in which the clots are so small that they make their way into the microvasculature at which point theres not much that can be done aside from giving medicines and hoping for the best.

Historically speaking this happened to you primarily through genetics based on the history you gave.

Prognostically speaking you have an ejection fraction of 71% which js very good.. Perfectly normal in fact.

I don't think youre going to get miraculously better, however i feel through diligent management theres a good possibility that the progress of the disease can be hampered.

So essentially, barring a sudden and severe myocardial infarct, you probably got many years left on the ole' ticker. Practically speaking, youre gonna be on the medications for life, and the list of meds is likely to get longer as opposed to shorter and id be suprised if anything done would have any more then a minor noticable positive impact on your physical state.
20748650 tn?1521032211
I almost forgot the stress echo.. Can you die from one, well yes possibly.. You can die in a car crash on the way to the doctor too..

Just remember youre going to be well monitored and you always have the ability to stop the test at any time.

It will be useful in helping rhe doctors identify any of the partially occluded arteries i mentioned in the first paragraphs of my first post. Its pretty important for managing this and keeping the disease from getting worse.
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