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Old 10-31-2004, 08:08 AM   #1
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How do you identify blockage other than by an angiogram?

I have lost a couple of friends recently, both in their 40s due to heart attack. One was a smoker and the other had quit a few years ago. Neither was overweight and both were in similar high stress occupations to my own. I am pretty concerned because in both cases they had a recent physical, one of them two weeks before he died which included an EKG. Both died due to significant blockage. I go to the gym 3 days a week which my friends did not as I find it to be a good stress reliever most of the time. I am very muscular from the weight training, 5'8" 200lbs,but I don't due as much cardio as I could.
I am an ex smoker as well. I understand I am probably not as high a risk as they were but still, it seems like there was no warning. For that kind of blockage shouldn't they have experienced pain or lethargy or something? I doubt I could just phone up my GP and demand an angiogram but is there other things I can look for? BP and EKG seem to tell nothing and these are the tests I get at my annual physical. Is there anything I can do that will reduce blockage or is it just a case of trying to reduce the further growth of it? Anyone have any thoughts on this?

 
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Old 10-31-2004, 11:11 AM   #2
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Re: How do you identify blockage other than by an angiogram?

There are tests which are indicative but not definitive for coronary artery blockages:

For example,

Ordinary stress tests
Nuclear stress tests

I had a nuclear (thallium) stress test about a month ago, and it indicated problems with two coronary arteries. So the cardiologist recommended an angiogram. But the angiogram showed no significant blockages.

The interpretation of my nuclear test is probably complicated by the fact that I had a severe heart attack 30 years ago, 6 bypasses 24 years ago, and have developed a great deal of corollary circulation. The cardiologist doing the angiogram said there was no reason to consider stents or a second bypass surgery.

So ultimately, the angiogram is probably the definitive test for blockage.

But if you're concerned about this, an ordinary stress test or nuclear stress test would probably relieve your mind about it.

Regards,
Bill

 
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Old 10-31-2004, 11:27 AM   #3
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Re: How do you identify blockage other than by an angiogram?

Thanks Bill. A stress test ounds like the place to start.

 
Old 10-31-2004, 02:29 PM   #4
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Re: How do you identify blockage other than by an angiogram?

Perry2, odds are that if you could talk to your friends, they would tell you that they did have some warnings or symptoms, prior to their heart attacks. They may have been ever so subtle or slight, but never the less, I believe they had some warning that they may have not understood. Some people deny or ignore these signs, and live to tell about them, after surviving a heart attack. I had had years of angina, but couldn't tell for sure, if it truly was angina. I was told by my cardiologist that the sensations that I was feeling, was due to stress. I too had a very stressful job (don't we all, lol). He told me that angina rarely occured while at rest. True, but I was one of the few to have unstable angina, which can occur while at rest. So I went with the odds but they didn't pay off. I passed 2 nuclear stress test (perfectly normal) prior to having a heart attack. The last of these 2 test was ~7 months before I had a HA. I don't have massive damage, but I do have damage to my heart. It has totally changed my life.
That's why that I believe it is so important to go to the doc, if you have unexplained chest pain. Then you take these dang stress test that aren't really that reliable, and end up having a heart attack anyway, but many are helped. You have to be persistent with the docs, and listen to your own body.
There are feverish attempts going on right now, to develop a way to image coronary artery blockage, in a non-invasive way. There are many competing forces in the marketplace, patents etc, but I think that we are close to getting a non-invasive test that is reliable. I have had 3 cardiac caths, and I don't like them at all. Some have had many more. I have a 40-45 % blockage now, in a very bad location. I will die if it progresses to >90 %. So I am very interested in watching this blockage, w/o having to have another cath. There is a fast ct scan that is great in imaging calcified arteries, but it doesn't image "soft plaque" blockages good at all. The Mri technology looks good for the future.
Stress test do not image coronary artery blockage. They image "blood perfusion" (flow) to the heart muscle. Obviously if your heart muscle is not receiving the proper blood flow, you can say that there is coronary artery blockages. The next step now is the cath, to identify the specific blockages.
Your friends may have not had any symptoms or warnings at all. If one has a blockage consisting of "unstable plaque" (plaque w/o a covering of hard type calcium), and they have a plaque rupture, it can cause a lethal heart attack, w/o symptoms.

 
Old 10-31-2004, 06:38 PM   #5
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Re: How do you identify blockage other than by an angiogram?

A non-invasive way to better detect blockages would save many lives. I know quite a few people who have died at young ages because they had sudden massive heart attacks. It happens everyday.

Also, regular check ups dont usually involve the complicated testing needed to find heart problems. An EKG can easily tell you if someone has had a heart attack but cant predict one in the future. Perhaps doctors dont do enough testing in people who are at a greater risk. The male smoker in his 40's who died should have been given a stress test during that physical.

 
Old 11-01-2004, 05:08 AM   #6
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Re: How do you identify blockage other than by an angiogram?

Perry,

Routine is now for stress tesing at 50 in symptomless individuals, earlier if any indications..."doctor, I sometimes get thus PAIN!"
I recommend that you have a stress test, with nuclear imaging if your insurance company will allow it without pre-certification. If it's a hassle, a stress test with plain echo is better than nothing. If you really, really, really want the nuclear scan, you might have to develop some "symptoms" that are completely subjective.

Have a blood lipid panel done with homocysteine and CR-P (cardia) thrown in at least every couple years.

I too wish there was good imaging to check on arterial status, doubly so since I have a stent to keep nice and shiny!

TAKING A DAILY ASPIRIN IS PROBABLY THE BEST WAY TO STAVE OFF A SUDDEN KILLER!

Last edited by zip2play; 11-01-2004 at 05:11 AM.

 
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