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Old 07-18-2007, 10:16 PM   #1
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Heart Cath. Questions

This is my second posting and an update on my situation. Last month I went in for my yearly Heart Ultrasound. I can't do the treadmill because of a bad back. After the test the Cardio. came in and said he had some bad news. It looked as though I had had a "heart attact" although he left some room open for other possibilties. So, he scheduled me for a Nuclear Stress Test. A few days after the Nuc Test he called me and said the latest test showed the same results as the first. Now he has me scheduled for a heart cath. July 29. He hasn't given me any other information. All I know is to show up at the Hospital at 5:30am. WHAT AM I IN FOR? Some background info: I am a 60 male and overwheight Gained 40lbs since I blew out my back 3 years ago. Take High BP Meds, have a bycusspused Aortic valve and accordingly a thickened heart muscle. I have never experiance chest pains other than indigestion. Any information you can give me as to what this procedure is all about, how dangerious it is and what to expect will be really appreciated.
Thanks in advance.
Bronco
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Old 07-19-2007, 06:03 AM   #2
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Re: Heart Cath. Questions

Bronco,

They will give you a lot of Plavix to prevent clotting and then snake a thin catheter into your femoral artery in your groin and up into your heart. This is done with a little local anaesthesia into your groin and something to relax you. Then they'll squirt a little dye into each of your coronary artery and take pictures to determine the degree of narrowing of the vessels. This takes about 1/2 hour.
Fatty plaque buildup causes these narrowings and interferes with the heart's ability to get nourishment under stress.

If they find any large blockages, they may angioplasty them (strectch with a balloon) and place a little spring (stent) to hold it open. No sense doing anything to the old blockage that caused your suspected heart atttack because that area has already resolved itself with scar tissure and collateral blood circulation.

Read all you can find about the procedure ahead of time so you can be an "informed consumer." There is low (but not no) risk to the angiogram, but greater risk of angioplasty and stent.

If they place a stent you will spend an overnight in the hospital, otherwise you will go home late in the day and have to be careful not to do anything that can cause the wound in your groin to start re-bleeding.

IF you've never had any heart pain and have a decent exercise level (yep, still possible with a blown back...I know ) then think conservatively becasue angioplasty and stent are primarily for SYMPTOMATIC relief, there is little evidence that they do anything to increase our life spans or decrease the risk of another heart attack.

Get on a program for lowering your cholesterol to superb levels amd take an aspirin every day if you don't already.

Last edited by Lenin; 07-19-2007 at 06:07 AM.

 
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Old 07-19-2007, 10:05 AM   #3
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Re: Heart Cath. Questions

Quote:
Originally Posted by Bronco View Post
This is my second posting and an update on my situation. Last month I went in for my yearly Heart Ultrasound. I can't do the treadmill because of a bad back. After the test the Cardio. came in and said he had some bad news. It looked as though I had had a "heart attact" although he left some room open for other possibilties. So, he scheduled me for a Nuclear Stress Test. A few days after the Nuc Test he called me and said the latest test showed the same results as the first. Now he has me scheduled for a heart cath. July 29. He hasn't given me any other information. All I know is to show up at the Hospital at 5:30am. WHAT AM I IN FOR? Some background info: I am a 60 male and overwheight Gained 40lbs since I blew out my back 3 years ago. Take High BP Meds, have a bycusspused Aortic valve and accordingly a thickened heart muscle. I have never experiance chest pains other than indigestion. Any information you can give me as to what this procedure is all about, how dangerious it is and what to expect will be really appreciated.
Thanks in advance.
Bronco
(Sleepless in Seattle)
Bronco, apparently, you have been diagnosed with cardiomyopath hypertrophy (thickened heart's wall). The condition, depending on degree, can impair heart contractions and dilate the left ventricle.

The aorta valve, when aged over 40, is usually due to some calcification, and it narrows the opening causing pressure and a decrease of the heart's output.

The hypertrophy and valve stenosis can cause ischemia (lack of blood to the heart muscle). Ischemia can cause a heart attack meaning there is heart muscle damage (necrosis). If the dx is correct, you probably had a silent MI. That happen to me 3 years ago...no warning until there was heart failure, then symptoms related to pulmonary edema. Symptoms of a heart problem can be indigestion and that could have been a warning?!.

You will be a wake during the test to co-operate in a change of position, etc. Medication reduces your anxiety to zero, and you will be relaxed and feel no pain. The test will be about determining chamber's gradient pressure, view the valves functionality and form, possibly taking a biopsy of the thicken wall. Risk is on the level of tooth extraction.

Because you have not experienced angina (chest pain, etc. during exertion), there is good possibility your coronary arteries are less than 70% blocked. Guidelines published by the AAC/AHA consider that degree of blockage doesn't require intervention (stent).

 
Old 07-19-2007, 03:34 PM   #4
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Re: Heart Cath. Questions

Bronco....Like stated earlier...you want to go ahead and do your research now. I had a stent put in 3 months ago...and kinda wish I didn't now. I hadn't done any research...didn't know I needed too....lol. Anyways my blockage was borderline inbetween 60% and 70%. They asked me what I wanted to do and I didn't know. I ended up having the stent and will spend the rest of my life on Plavix now. Lenin is correct the research show that it doen't lengthen your life, it just stops the pain. I have to admit that I havn't had any chest pain since I had the stent put in so I guess that is good. My only complant is I am alergic to plavix...so I'm trying to reseach alternatives....but that is why I say if I had to do again I might do different???? Who knows...but do your research now!!! Treze

 
Old 07-19-2007, 06:32 PM   #5
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Re: Heart Cath. Questions

jag,

Why do you have to be on Plavix on you life? Plavix is recommended for about a year or more with DES. Take an aspirin to keep the blood thin.

Where is the evidence opening a blocked artery does or doesn't increase longivity? Its common sense if someone has a blocked artery there is a higher risk than an unblocked artery (stent) for heart muscle cell damage due to ischemia that can cause heart failure or a heart attack.

I had silent ischemia that caused heart damage. What research is there that concludes if I had had a timely stent implant I would have experienced an MI anyway. An MI is life threatening and evidence supports a shorter life span. Keep the vessels open with another stent or a by-pass if necessary that makes a difference in life span.

Granted some are given stent implants to relieve pain, and forego medication that possibly could keep the vessels open and relieve pain. There is some questionable evidence that supports medication and a stent implant are about equal in terms longivity.

 
Old 07-20-2007, 06:19 AM   #6
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Re: Heart Cath. Questions

Ken...You are right I believe that in a lot of cases that stenting is very useful. In my case of inbetween 60% and 70% I believe that if I had done my research I would have chose not to stent...atleast at those percentages. My Cardiologist recommended that I be on plavix for life...but at a minimum of 2 years. My cardiologist gave me a option of stenting or medication...but I was in the cath lab and hadn't done any research. He made it clear that it would open my artery and stop my angina. But he also said that it could be treated with medication. I was druged and scared and I asked him would you get a stent and he said yes. That was all it took for me I said do it. I just think if I had done a little research I might have tried treating with medication first. I didn't have time. I had been having chest pains over 7 years and had past all my test...so I just assumed that I would get the usual..."nothing is wrong with your heart". So I was shocked when I was rushed to the Cath Lab. My Cardio thought my LAD was 95% blocked..but cath showed different. I believe knowledge is power and the more you know going in, the better decision you can make. My stent procedure cost over $40,000...and to come out and do research and see all the controversy over stenting and medicated stents was quite alarming. Over all you are correct. I have met several people that were having MI's that stenting saved their life. In my personal case...it was for pain relief...long term I hope it will lengthen my life. Only time will tell. Bronco...I was in no way of telling you to no get a stent if needed....I was just suggesting that you do your research now before going in so you can make an educated decision. Im 38 year old woman trying to be as educatated as possible so I can beat this disease and live to see my daughter grow up. Best of luck...jag

 
Old 07-22-2007, 09:21 AM   #7
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Re: Heart Cath. Questions

Quote:
Where is the evidence opening a blocked artery does or doesn't increase longivity? Its common sense if someone has a blocked artery there is a higher risk than an unblocked artery (stent) for heart muscle cell damage due to ischemia that can cause heart failure or a heart attack.
The evidence is the COURAGE STUDY done by the VA and completed this year.

To my way of thinking, I don't see the "common sense" element as at all persuasive...why would we think that squooshing a plaque to the side and holding it there with a spring would be anything but ham-handed compared to the subtle care that our bodies take in capping and stabilizing such a lesion. I have always been fearful of the thought of mangling the plaque with wires and the resulting instability. Remember, STABLE plaque doesn't kill...but broken plaque cause heart attacks.

In any case the COURAGE study was persuasive: there is no advantage to angio-stent in either increasing life expectancy or in avoiding MI for people with stable angina. There may have been some statistically indeterminate advantage in comfort level for angio over drugs but not conclusively.

For MY condition and my angina level, if I knew THEN what I know now, I think I would have to join jaguar...all things considered there is a high likelihood I'd have opted for the drugs, or indeed NOTHING but extreme LDL control. Alas, I wasn't as informed as I should have been...or indeed COULD have been...some things (like the COURAGE STUDY) weren't available to me 3 years ago.

Last edited by Lenin; 07-22-2007 at 09:24 AM.

 
Old 07-22-2007, 11:54 AM   #8
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Re: Heart Cath. Questions

Stents prevent heart attacks, heart damage, and death. I have 4 stents in my Lad and 1 in my Lcx. Each stent in my Lad represents death avoided by opening up this artery. Most cannot live if this artery closes. It supplies the left ventricle and other areas of the heart. I believe a "widowmaker" heart attack involves closure of this coronary artery. The widowmaker may also involve the location of the blockage in the Lad, i.e. being in the proximal (beginning). My Lcx is dominant, so this stent was surely a life saver.

I know how I have felt before each of these stents were inserted. I also did not have the energy to walk across a room. Angina was extreme in each case. My cardios always knew that they could count on the severity of my angina to know that I would need an interventional procedure (stenting or bypass surgery)

I have never had an Interventional Cardiologist to ask me whether I wanted a stent, after the angiogram had located the stent, during the cath. I had already signed paperwork that gave my approval to be stented if necessary. So they would say MR X, we need to place a stent here.

I don't mean to be insensitive to the results of the "Courage" study. It is just of no benefit to one who is facing a heart attack from coronary artery disease (CAD), with a 95% blockage of the Lad, and lying on a cath table. It is a look at long term survival rates of CAD patients who were treated with medicines versus interventional procedures, stents/angioplasty, excluding bypass surgery.

I have extremely high cholesterol and cannot tolerate statins. Medicine does not always work. That is what I was told after my 1st of 9 cardiac catheterizations. The 1st was after a heart attack whereby my Ramus coronary artery went fully closed. Nothing could be done for this artery, but a few other blockages were discovered but still too small to stent. The rule of thumb or guidelines for stenting is a blockage >70%. Medicine didn't work for me.

Each of us is unique in our arterial supply to our heart muscle. My Rca is tiny and insignificant. I am left dominant. Only 10% of the population are left dominant. This means that my Lad and Lcx are really all that I have to supply my Pla and Pda and probably more arteries that I am not aware of.

All of this has to be taken into consideration by the doctors when performing interventional procedures.

I also wanted to mention that stable plaque can also causes heart attacks by their actual size, and can rupture the same as unstable plaques, just not as often. Of course I would love for all of my plaque to be stable if I have to have it

Peace out

 
Old 07-22-2007, 06:59 PM   #9
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Re: Heart Cath. Questions

Wow, thanks for all the information from all of you. As I said, I was scheduled for the Heart cath. (is that the same as an Angiogram) but new I had some problems with my teeth. I have heard that after a placement of a stent they have you on blood thinners for a year or more. Anyway, I went to my Dentist and sure enough I have 5 teeth that need to be removed. So I past this info on to my Cardio and he decided to postpone the Cath. for up to three months. He gave me a prescription for Nitro Patches and said to call him when my teeth were taken care of. I would have to assume my condition is not as serious as some but you know what happens when you assume something. Has anyone used the Nitro Patches?
Thanks,
Bronco

 
Old 07-22-2007, 10:07 PM   #10
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Re: Heart Cath. Questions

Quote:
Originally Posted by Bronco View Post
Wow, thanks for all the information from all of you. As I said, I was scheduled for the Heart cath. (is that the same as an Angiogram) but new I had some problems with my teeth. I have heard that after a placement of a stent they have you on blood thinners for a year or more. Anyway, I went to my Dentist and sure enough I have 5 teeth that need to be removed. So I past this info on to my Cardio and he decided to postpone the Cath. for up to three months. He gave me a prescription for Nitro Patches and said to call him when my teeth were taken care of. I would have to assume my condition is not as serious as some but you know what happens when you assume something. Has anyone used the Nitro Patches?
Thanks,
Bronco
Hi im everret86 i just joind and looking around on this site. im 21 years old and have carteio myhopothy inlrg hart. my brother hase the same thing i have also as my dad did b4 his conjustof haert failyer wich led to a trans plant. my problem is my hart has been geting worse andim going threw all these test i never done befor im geting reasalts back from my stress test then i hace a heart cath comeing up. i was hopeing that maby i could tell me what it was like. i tr not to ask my dad to much about this stuff beacus a cant stand the look on his face when i do. so i would apreasheat it if i knew what im geting into. thanks
everett86

 
Old 07-23-2007, 10:26 AM   #11
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Re: Heart Cath. Questions

Bronco,

If you have never experienced any heart pain then you probably have no need for the nitro patches. Nitro is for relief of angina (pain.) If you DO take it, the most ususal side efect is headache and a speedup of the heart rate.
Daily aspirin however is a good idea up until a week before you have those teeth yanked.

If your only condition is an old heart attack that never caused you any problems then that ship has sailed, all the damage it will do has probably already been done and there's no point in medicating it with an anti-angina med.

Last edited by Lenin; 07-23-2007 at 10:31 AM.

 
Old 07-23-2007, 10:37 AM   #12
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Re: Heart Cath. Questions

Courage study doesn't really present anything new, but simply reinforces that the basis for the control of ischemia. No surprise in that! Granted there are many unnecessarily drawn or sucked into a cath lab.

Courage is patient selective (stable v. unstable angina) and doesn't include patients with MI or other serious problems. I had a 98% blocked RCA that indirectly caused an enlarged LV and mitral valve redgurgitation. The intervention (stent implant) provided immediate blood flow to the distal portion of the damaged heart and MEDICATION reduced LV remodeling and MV regurgitation.

Patients with chronic stable angina represent about 30%. I had/have a 72% circumflex that I refused to have it stented especially after I asked the doc what that would do for me? (answer, just a shrug).

I take exception to the comment there is a need for a stent only if there is angina. And there is no significant difference in longivity with stents or medication! It depends on the patient's medical circumstances and condition. Results and what procedure (stent, medication therapy) is patient dependant.

 
Old 07-23-2007, 04:38 PM   #13
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Re: Heart Cath. Questions

Quote:
Originally Posted by Lenin View Post
Bronco,

If your only condition is an old heart attack that never caused you any problems then that ship has sailed, all the damage it will do has probably already been done and there's no point in medicating it with an anti-angina med.
Bronco, cell damage can be an ongoing physiological pathology due to insufficient blood supply to an area of the heart. It does not require angina to be treated, just the knowledge there is ischemia.

I have no angina, but the perscription for long acting Isosorbide tablet (nitrate) is recommended. The medication relaxes heart vessels and this gives some assurance for optimum blood flow for daily activities. I take 2 tablets a day and no side effects.
________________________________________ _______
Huckfinn, you have an interesting and complicated cardio/vascular. Haven't heard about left dominant. You articulate well the exceptions to the "Courage" study as the study is narrowly focused. People that have diabetes are another excepton due to an intolerance to some medication.

QUOTE " Stents prevent heart attacks, heart damage, and death. I have 4 stents in my Lad and 1 in my Lcx. Each stent in my Lad represents death avoided by opening up this artery. Most cannot live if this artery closes. It supplies the left ventricle and other areas of the heart. I believe a "widowmaker" heart attack involves closure of this coronary artery. The widowmaker may also involve the location of the blockage in the Lad, i.e. being in the proximal (beginning). My Lcx is dominant, so this stent was surely a life saver".

I have a totally blocked LAD and 42% block of the LCX. From what I understand, where the circumflex branches from the LAD is very vulnerable to blockage due to blood turbulence at the site of branch, and as a consequence of the branch site the area is very difficult to stent. Stent one vessel blocks the other. Need a "Y" stent.

I have a completely blocked LAD, but collateral vessels provide natural bypass at the location just below the branch. With all your blockage problem, hasn't there been some angiogenesis and/or collateral vessels?

Last edited by started04; 07-23-2007 at 04:40 PM.

 
Old 09-01-2007, 10:09 PM   #14
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Re: Heart Cath. Questions

Quote:
Originally Posted by kenkeith View Post
jag,

Why do you have to be on Plavix on you life? Plavix is recommended for about a year or more with DES. Take an aspirin to keep the blood thin.

Where is the evidence opening a blocked artery does or doesn't increase longivity? Its common sense if someone has a blocked artery there is a higher risk than an unblocked artery (stent) for heart muscle cell damage due to ischemia that can cause heart failure or a heart attack.

I had silent ischemia that caused heart damage. What research is there that concludes if I had had a timely stent implant I would have experienced an MI anyway. An MI is life threatening and evidence supports a shorter life span. Keep the vessels open with another stent or a by-pass if necessary that makes a difference in life span.

Granted some are given stent implants to relieve pain, and forego medication that possibly could keep the vessels open and relieve pain. There is some questionable evidence that supports medication and a stent implant are about equal in terms longivity.

 
Old 09-01-2007, 10:23 PM   #15
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Re: Heart Cath. Questions

Yes,it is true that once you had stents put in they want you on Plavix forever.I am also taking a baby asprin daily.I had open heart surgery first and was told Plavix was to be taken for a few months but then my bypasses collapsed and I had those redone with stents so now I am told it's Plavix for life.If my open heart would have been successful I would have been off Plavix a long time ago. My mom had her open heart 2 months after me and since hers was a successful surgery (Thank the good Lord above) she only had to be on Plavix a few months.

 
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