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976897 tn?1379171202

meeting with cardiologist who re-opened my LAD

Finally had meeting with him yesterday and I have to say that I'm very confused, perhaps it's a good thing I have a meeting in two weeks with another cardiologist in a different hospital. This is how the meeting went.

Cardiologist :  It's really good to see you, it was considered by many cardiologists that the procedure would not work or wouldn't last very long, but seeing you sitting here is proof it did. How are you feeling?

Me :  Disappointed. My angina has not improved at all, I expected to be running around. The only difference I've noticed is that I can comfortably breath cold air. Throat discomfort, aching jaw, chest pains, shortness of breath are the same on exertion.

Cardiologist : Well, your heart is now in excellent shape, your LAD has a better supply than most people of your age. Whatever is going on is not the heart.

Me : Well I beg to differ. I've lived with angina for years and I do know the symptoms. What else could give these problems upon exertion if not angina.

Cardiologist : Well it is possible that a smaller vessel was overlooked and this could cause angina. I will have a re-study of your angio and see what I can find. Your arteries do tend to spasm also, we noticed a lot of this during the procedure, they were actually quite wild.

Me : Well with the amount of work performed wouldn't this be expected. It doesn't mean they spasm without a catheter moving around inside or balloons being inflated. Besides, isn't a spasm spontaneous? are you saying my
LAD goes into spasm with exertion only?

Cardiologist : No you are correct, I will look at your angio and see what I can find. I will write to your GP and suggest you wear a Nitro patch which should help. Whatever is going on, I still don't think it's your heart.

Me : Well, I was here two days ago and had a stress echo. They were able to reproduce my throat discomfort and chest pains with a 10 out of 10 extremity of pain. I'm sure you would have seen the results and surely this points to the heart and nothing else.

Cardiologist : I didn't know you was referred for a stress test. I have no results and I will find out and access them. You are right, it does seem to point to the heart. I will have to have another good look at your case.

Me : I had a lung function test last week also, and the results were very good, above average. However, this test did not look at oxygen concentration in the blood, it simply checked the physical ability and volume of the lungs. I take it you remember doing my procedure?

Cardiologist : Oh yes, I remember your procedure very well, just like it was yesterday. It was very challenging to say the least.

Me : So can you please explain to me what happened in recovery when my HR went to 220 + and I was knocked out with medication.

Cardiologist : When I was initially removing the first section of plaque in the 100% blockage (chipping away at it), the catheter broke through the artery wall. It didn't seem to be posing a problem at the time, there was no bleeding. I continued to remove the blockage and put in a long stent. I then proceeded all the way down the LAD because it was completely lined with Plaque, but not very thick, probably 20% in the worst part. I ballooned and stented with 4 more long stents. In recovery, the LAD split slightly where the catheter broke through the wall, causing your heart rate to increase. Your oxygen level reduced and we quickly got you back into the angio suite where I repaired the vessel and
put in a small stent. So, you had 5 long stents and one small one in total.

What medication are you currently taking?

Me : Aspirin/Plavix/Atorvastatin/Ezetimibe

Cardiologist :  So no beta blockers?

Me : No, I hate those things

Cardiologist : That's great, you can stay off them. I will do the letter to your GP, re-study your case. I want to see you again in 6 months, but if I see anything obvious then I will certainly be getting you back in.

So as you can see, yet again there is a lot of confusion over what can be causing my Angina. I will be writing a letter to my GP outlining all the events so there is a record of it. According to him, with my LAD so wide, I should be running around with no problems but I really wish that was the case. I feel like they believe I am imagining the symptoms and I wish we could swap bodys for half an hour so they can see/feel exactly what it feels like.
6 Responses
712042 tn?1254572809
I don't know where my posts to you are going but this will be my 3rd time: There is no confusion here with regard to your angina. Attribute this angina to the microvessels and possibily the addition of spasm which can start with the microvessels at the end of the larger coronary and travel up the coronary. Try the nitro patch. No to beta blockers and yes to CCB. My LAD and all other coronaries are nice and open and large. It's the microvessels that are involved giving me the variant angina and I have vasospasms. Read my journal and posts here at the Cardiac Microvascular Dysfunction forum. Joan.  
976897 tn?1379171202
Maybe I simply attempt to apply too much logic. Here's my way of thinking.....
Up until Jan 06, no problems at all, very fit.
Jan 06 severe chest pains, diagnosed as stomach.
Feb 06-Feb 07 worked in building trade, no problems, very fit.
Feb 07 MI attacks, stent applied to obtuse marginal (OM1).
Felt fit again even though LAD totally blocked, very narrow and fed by collaterals.
No angina.
May 07 Perfusion scan, excellent results.
Aug 07 Angina symptoms, angio revealed no change to LAD, more disease in RCA.
Sep 07 Triple bypass to LAD. Noticed no real benefits and the vessels failed in 3mths.
Mar 08 New angio. LAD same as Feb 07, RCA still very diseased.
May 08 Perfusion scan, excellent results.
Sept 09 LAD opened with stents. No real benefits. Angina symptoms.

I have missed out some tests which are irrelevant because they show perfect results, such as echo revealing 70%ef.
Looking at this history, I believe the culprit is the RCA yet they keep looking at the left side. They keep saying the right is being fed from the left or something, but surely angina can originate from right side.
Doesn't this look logically like it could be the case?
712042 tn?1254572809
I'll give you my email address later. Please respond so I can send you a published article from the journal of  Heart, Lung and Circulation 2008. And surely angina can originate from the microvessels, and not show up on any tests? Why the reluctance to try nitro and see if it helps? Like a test? Joan, with variant angina and no positive test results and no blocked vessels.
976897 tn?1379171202
I'm not reluctant to try the nitro patch. What bothers me about this test is that it can relieve many problems and I will never know the cause. For example, if I have a small artery with a blockage causing the angina, a branch off the LAD, with say a 90% blockage, the nitro patch will relieve this. If my LAD goes into spasm, there is a good chance the nitro will prevent this. If I have microvascular disease, then the Nitro will relieve this too. There are other possibilities also, but I will stop here. So, with so many causes being relieved by one medication, how will I ever know what the problem is?
I guess I'm one of those people who want to know what the problem is, not just be glad it has been relieved, whatever it was. If Nitro works for a year, then the symtoms return, then what? If nitro no longer works, the original cause has obviously become a lot worse but nobody knows what it is. Am I thinking wrong here?
712042 tn?1254572809
I speak specifically to exertion and resultant cardiac demand. I assure you that the nitro only relieves the angina pain and chest tightness; it will not completely eliminate the angina/chest tight/SOB as each demand and compounded/layered demand will be different.It would help if a MI of a larger coronary occurred, but certainly not prevent an infarct. If you were to have MVD with CAD then, as you have read,the reason for the problem may not be defined for a LONG time to come. Nitro,along with a CCB reduces spasms and you know you do not want an irritable LAD.You would have the choice to use nitro only during day time, or on those days that you would have some 'known to you' cause of symptoms(some cardiac demand occurring).There's no wrong thinking here but I would think towards a better quality of life to keep LAD in check and dilate all those cardiac vessels for better perfusion and decreased ischemia/pain.I would love to know the genesis of MVD and find no relief in just the angina relief. Joan.
Avatar universal
Hi Ed

It sounds to me that starting afresh with a new cardiologist might be a good idea.  You can then ask the new one the questions about the RCA and ask why they wouldn't think it's that.  

It's good you've had the treatment you've had but it sounds like you are not fully there yet and I understand you wanting to totally understand whats going on.
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