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Old 05-19-2005, 04:58 AM   #1
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Point me to some articles, please.

Good morning!

I had a major heart attack about 2 years ago. At the time I was outfitted with a stent and put on aspirin, a beta-blocker and an ACE inhibitor and sentenced to the usual program of aerobic exercise. It turns out that my arteries are in perfect condition, and later, with the results of more tests, it was guessed that the heart attack was caused by some clotting problem.

Can anyone point me to GOOD, SERIOUS, DETAILED articles evaluating beta blockers, ACE inhibitors, or exercise in cases like these, or which might give a rationale why any of them should help. If the heart attack was caused by some thrombotic event, I can't see what my heart rate, etc., have to do with it.

Thanks.
Cassy.

 
Old 05-19-2005, 05:50 AM   #2
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Re: Point me to some articles, please.

Quote:
Originally Posted by Willdo
Obviously you had a coronary artery blockage in the past, or they wouldn't have inserted a stent. That's what stents are for. You have a medical malpractice suit if they inserted the stent for no reason.
It may be obvious, but like many things which are obvious, it is incorrect in this context. The blood flow in one of my coronary arteries was completely blocked, yet observations made at the time, during a previous catheterization, and during later imaging studies confirmed that there was no atherosclerosis (very unusual in an American my age). I don't know whether the decision was correct, but the gentleman who did the catheterization decided to insert a stent, even though he did not know what was causing the blockage. I saw the video, with live narration by a very experienced cardiologist, and I understand that it is reasonable normal that one can see the blood flow or lack thereof without seeing the cause.

Quote:
You can go to the American Heart Association, ot the National Institutes of Health, and find that these medicines extend the lives of people whao have had heart attacks. They are standard medical therapy for survivors of heart attacks.
I thought that it was clear that I was asking for pointers to specific articles on this specific combination of cause and treatment, which I don't understand. I am aware of the fact that they are standard therapy, but I doubt that the statistics comparing the survival of heart patients in general mean much when N gets down to 1 and the circumstances are unusual. That's why I'd like to see what's written about such cases.

Quote:
If you did have a major heart attack, your heart would have received major damage.
No, I did not have a major heart attack. I said that I did because I was lying. And deranged. The doctors who all agree on this point are also lying and deranged. Or I imagined them, and they don't exist at all.

Quote:
Beta blockers take a load off the heart, and make you lazy.
I don't understand how taking a load off of my heart is supposed to prevent thrombosis, or prevent a heart attack by any other means. That's why I asked the question. And I think that I'm already sufficiently lazy, but the point is arguable.

Thanks.
Cassy

 
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Old 05-19-2005, 06:24 AM   #3
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heartcreature HB User
Re: Point me to some articles, please.

If anyone pointed you toward articles they would be in violation of posting rules here and would be banned.

 
Old 05-19-2005, 06:38 AM   #4
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Re: Point me to some articles, please.

I didn't realize that.

T
C

 
Old 05-19-2005, 07:07 AM   #5
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Re: Point me to some articles, please.

Quote:
Originally Posted by Cassandra999
It may be obvious, but like many things which are obvious, it is incorrect in this context. The blood flow in one of my coronary arteries was completely blocked, yet observations made at the time, during a previous catheterization, and during later imaging studies confirmed that there was no atherosclerosis (very unusual in an American my age).
I understand what you are saying: since you did see the occlusion, due to thrombosis, there is confusion because no visible atherosclerosis was evident in the angiogram of the coronary arteries. What is not excluded from possibilities is that the plaque formation was either so small that it is not observable readily at this time (which can happen) and still result in a rupture and clot formation. Another possibility is that there are atherosclerotic lesions external the areas imaged in the angiogram. I don't know the answer, but I did want to point out that those two possibilities should be considered.

Quote:
Originally Posted by Cassandra999
I don't know whether the decision was correct, but the gentleman who did the catheterization decided to insert a stent, even though he did not know what was causing the blockage. I saw the video, with live narration by a very experienced cardiologist, and I understand that it is reasonable normal that one can see the blood flow or lack thereof without seeing the cause.
Could be worse--could have been a bypass as would have been a decade or so ago.

Quote:
Originally Posted by Cassandra999
I thought that it was clear that I was asking for pointers to specific articles on this specific combination of cause and treatment, which I don't understand.
I think Willdo was doing that and giving you the flexibility to choose the articles you want to read, because if you go to the nih site, you will run across many when you search. Often, when I do a literature search for a manuscript that I am writing for work or personal-related background information, I use the medline website.

 
Old 05-20-2005, 12:37 AM   #6
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Re: Point me to some articles, please.

Quote:
Originally Posted by Willdo
saying I am sorry for the response I gave.
Apology accepted, and we can start all over again.

Quote:
Originally Posted by Willdo
It's just that our understanding of heart disease is very different. That's not to say that you are wrong and I am right. You just made some statements that shocked me. Most ER's give heparin injections in the tummy, when they suspect a heart attack. Heparin is a super clot busting drug that works very well if given in time, I have read. I have had 3 injections, and they burn like the dickens.
The cardiologist on duty who accepted me directly to the intensive care cubicle attached to the catheterization lab said that if I didn't agree to the catheterization (which culminated in the stenting), then they would heparinize me, but that in their hospital that was considered second best, as being both less effective and more dangerous than catheterization and its follow-ups. Since I did agree to the catheterization, they did nothing further except for assembling a catheterization team (it was about 1:00 AM), and except for what the team from the mobile intensive care unit had already done to stabilize me before moving me.
I was never in the ER at all. In fact, the team from the mobile unit talked me into going to that hospital, which has a bad reputation, because they could accept people me directly from the mobile unit to the cardiac intensive care unit, without going through the ER, which is the way the mobile people like to do it.

Quote:
Originally Posted by Willdo
There is a new board here, where you can ask for specific information and links. Look above and you will see it. It is for research. One lady that was improperly diagnosed with cancer, has started a website devoted to help people with research into almost any subject. I haven't took a good look at the site yet, but she posted the url on the research board.
I don't see the research board from this view, but I'll wander around the site until I find it.

Thanks.
Cassy.

 
Old 05-20-2005, 12:50 AM   #7
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Re: Point me to some articles, please.

Quote:
Originally Posted by CobaltBlue
I understand what you are saying: since you did see the occlusion, due to thrombosis, there is confusion because no visible atherosclerosis was evident in the angiogram of the coronary arteries. What is not excluded from possibilities is that the plaque formation was either so small that it is not observable readily at this time (which can happen) and still result in a rupture and clot formation. Another possibility is that there are atherosclerotic lesions external the areas imaged in the angiogram. I don't know the answer, but I did want to point out that those two possibilities should be considered.
All of these are possibilities. I gather that the doctor who was narrating the video for me months later also considered an embolism from some distant source a possibility.



Quote:
Originally Posted by CobaltBlue
Could be worse--could have been a bypass as would have been a decade or so ago.
I have no complaints at all about the way the acute situation was handled, especially since the people involved were dealing with an infarct classified as "extensive" at 1:00AM on a Friday night. My only complaints are some minor ones about lack of communication and an apparent lack of imagination since I have been passed to the demesne of the cardiologists who handle the chronic problems.


Quote:
Originally Posted by CobaltBlue
Often, when I do a literature search for a manuscript that I am writing for work or personal-related background information, I use the medline website.
I tried that, but found nothing useful. A doctor who answered me on another board said that I wasn't likely to find much good work on cases like mine, because they're not that common.

Thanks.
Cassy.

 
Old 05-20-2005, 05:40 AM   #8
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Lenin HB UserLenin HB UserLenin HB UserLenin HB UserLenin HB UserLenin HB User
Re: Point me to some articles, please.

I'm surprised that nobody at the hospital mention the two (or more now?) clot-buster drugs like streptokinase or the rt-PA's.
I know they aren't much good after 6 hours of heart attack, so maybe time was a factor?

 
Old 05-20-2005, 06:42 AM   #9
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Re: Point me to some articles, please.

No, from the beginning of the heart attack to the time I reached the hospital was about an hour, or an hour and a half. About 1/2 hour from the time the attack began (I realized that it was a heart attack within seconds) until we called the mobile intensive care unit, about 1 minute until they came (Really! But they may have been by chance in the neighborhood for all I know), and about 1/2 hour-1 hour until they had treated me and decided that it was time to move me. And the only anti-coagulant that they gave me was aspirin.

 
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