heart attack

[mpxrajan]

Hi
I had heart attack during July 1996(14 years back at the age of 38) and it was diagonised as Acute myocordial infarction  (Anteroseptal ) and I was treated After one moth of treatment I had a stress test and was tested up to 174 heart rate and my ejection fraction was 53% during echo cardiogram.I continuned with daily 1 tablet of Nitrocontinn for few years.
Now past 2 years I have stopped taking the Nitrates and I was regular on excersis(walking/gym) and i never had chest pain since 1996.
Recently I went for a medical check up and as the EKG was abnormal and absent R wave  I was told to go in for a MYO VIEW test.
I walked 10 minutes stopping in stage IV as I had reached the peak heart rate of 167(my age now is 53)
the observation given in the report :
1. Normal exercise capacity and conditioning for age and gender.
2. no ischemic symptoms with testing
3. No ischemic EKG changes
4.No arrhythmia
5. blood pressure rose normally from 110/70 to 186/80.
ejection fraction 47  TID 96
Anteroseptal wall large infarct.
my blood report:
cholesterol total    220
HDL cholesterol    38
Triglycerides         238
LDL cholesterol     134
Fasting gucose     80
and all other blood/urine tests are normal except VitminD 13
my weight is 184 lb and my height 5' 6".
Now I have statrted taking cholesterol lowering drug and asprin .
At this condition is it neccessary for me to go in for Angio gram ?
Can I go for daily speed walking and a game of tennis?
what all the other precautions is to be taken?

[kenkeith]

In response to another thread....Don't be confused!  An "angio" (angiogram) is by definition an evaluation of the coronary arteries with a contrast medium.  Several months ago I had a CT angiogram 128 slice and that does not have the risk associated with a cath angiogram or any other cath intervention and the risks includes blood clots (responded recently to post with that condition), there can be infection at the site of the cath penetration, there can be rupture of the vessel lining, etc. The cath angiogram has the advantage of a stent implant at the time of the procedure.

The CT scan (state-of-the art 258 slice has very little radiation risk and doesn't require slowing the heart rate below 60bpm, and the presentation is 3D and shows blood flow (the fourth dimension). The CT angiogram has the advantage of viewing the anatomy of the vessels and that includes the soft plaque within one of the three linings.  Soft plaque has the highest risk, and that risk is the rupture of the soft plaque into the lumen channel), and that event is accountable for the largest percentage of heart attacks as any cardiologist will trell you.  The CT  also views the lumen for any hard plaque. Inaddion, the procedure views lungs, aorta (ascending, arch and descending).  I was pleased with the outcome of my test although there was high calcium score indicating soft plaque.

There indivduals that have normal EF and don't feel well, and individuals with an EF below 30% and feel well.  In fact there are about 26% of the heart population that don't know they have a heart problem and carry on with their regular activities. There are many medical variables and some variables compensate very well for heart failure.

[kenkeith]

It appears Cindy707 has given you advice to consult with a doctor on a previous post regarding your concern with exercise.  It appeared you were concerned with your EF differential on this thread, and I answered that concern.

Ed has expressed it well and addresses your activity concern, and I agree with his perspective on the subject as it really comes down to what your response is to a particular activity.  For instance a particular activity may be considered OK, but one may be under more stress on a particular day, cold weather, or had just eaten a large meal, etc. and to engage in a particular activity that had been considered safe may pose a risk, and under those circumstancesbe it would be prudent to slow down or stop the activity. Also, learn your own limitations, but based on the results of a stress test, you have very few activities limitations.

[ed34]

With regards to activities, the saying goes that you can do anything you like as long as you slow down if you feel strange symptoms. For example, if you feel light headed, chest pains, throat discomfort, sudden jaw ache, pains in arms/shoulders etc, then just ease down and let your heart and circulatory system go down a gear. You have to basically learn your own limitations because every single person is different. If you do feel chest pains starting, just stop what you are doing and they should vanish within a couple of minutes.

[kenkeith]

An MI with heart cell damage to the septum does not have much effect on the heart's ability to pump adequately as shown by your low normal EF (normal 50-70%).  That is because the septum (wall between left and right chambers) remains somewhat rigid as the pressure within each chamber applies almost equal pressure against the septum during systole.

There appears to a lower unexplained drop in the EF from 53% to 47%. If you consider the margin of error of about 5%, your EF is about the same.  Also, the EF is variable as is the heart rate and blood pressure.  All 3 factors adjust to various levels and are interrelated to maintain a balance of blood flow between the right and left side. When the heart normally dialtes that causes stronger contraction and more blood is pumped with each stroke, etc. So it is not unexpected to have a variation of the EF from one test to another.

Hope that gives you a perspective, and feel free to respond if you have any further questions.  Take care and thanks for sharing.