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Old 08-20-2007, 01:16 PM   #1
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Admitted to hospital & waiting for an angiogram

Merrilly plodding our way thro life when all of a sudden my hubby (48) got taken in for chest pain. We've been told not a heart attack (from bloods) but he has to have an angiogram. Dr is now talking about a stent, etc but as he is still waiting to have the angiogram we are still in limbo. What will happen if he has to have a stent? Will he be able to have a normal life? So confused and worried, I'm 40 and we have no children - so scared of losing him. Any info from anyone who's been in a similar situation greatly appreciated.

Thnx

 
Old 08-20-2007, 03:04 PM   #2
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Re: Admitted to hospital & waiting for an angiogram

Hi, been there, and did the stent thing 6 months ago. My husband was also 48 at the time, and he had a slight heart attack. They put a stent in his blocked artery to reopen it and re-establish the blood flow. They will probably do a catherization on your husband-in other words-go up thru an artery in the leg and shoot dye, this will show where the blockage is, and they will do angioplasty,angioplasty is where a ballon is inflated at the sight of the blockage, and this busts up the occlusion, and they then insert a stent to keep the blockage open. Your hubby is very lucky tht he did not have a heart attack,thus probably no damage to the heart. An angiogram (I believe) is basically shooting dye thru the heart vessels, and this will show any blockages. Hope this helps.

 
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Old 08-20-2007, 03:56 PM   #3
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Re: Admitted to hospital & waiting for an angiogram

Hi Niki:

Sorry to hear about your husband. The good news is that they told you it was not a heart attack, based on his blood works. There could be other reasons for his chest pain. It seems to me that the talk about placing a stent before they even did the angiogram to determine the cause of his chest pain is premature.

A lot has been written lately about doctors rushing in to place stents as a routine procedure because it has been such a cash cow for them. So the first step is to confirm through various tests that there actually was no heart attack. The ultimate test to check the condition of his coronary arteries is of course the angiogram which will determine the location and extent (if any) of any blockages (and he is awaiting that.) Based on those results, the decision will be made whether to place a stent/stents. With the controversy about the safety of drug-eluting stents lately, another decision will have to be made whether to place a bare-metal stent instead of the drug eluting stent. A third decision to consider is whether to place any stent at all vs. just doing an angioplasty followed by life-style changes such as medication, diet, exercise, stop smoking, stress reduction etc. However, nowadays, most cardiologists will usually go the stent route rather angioplasty alone. There was a recent study done that showed that such lifestyle changes alone as opposed to angioplasty and stenting produced very similar results after a five year period.

In summary, if he does need a stent, your options are:

1. Angioplasty with placement of a drug-eluting (medicated) stent which will entail a long term anticoagulant therapy i.e. Plavix for at least one year or more (some cardiologists say life-time since the news about late-stent thrombosis) in addition to aspirin. Such long-term therapy carry the risk of bleeding in some patients and in many cases needed surgeries cannot be performed since stopping the plavix to do the surgery raises the risk of thrombosis and heart attack.

2. Angioplasty with placement of a bare-metal stent. Many cardiologists are going back to using this old style stent since the news about the higher risk of the newer drug-eluting stents. There is a higher risk of stenosing with this kind of stent in the early stages after the heart attack but the risk of late-stent thrombosis (which is more dangerous) is less than the drug-eluting stent. The need for plavix on this kind of stent is much shorter in duration and here is where its advantage lies. You still have to be on life-time Aspirin therapy.

3. Angioplasty alone with no stent placement. (Unlikely)

4. Life-style changes alone as mentioned above with no invasive procedures.

Of course, regardless of which route to take, life-style changes still need to be followed.

If a stent has to be placed, ask if they use the latest technology (IVUS) to make sure the stent is properly placed. There has been a study that showed most of the stents placed (without IVUS) were either imperfectly or improperly placed resulting in complications.

Let us hope that you do not have to grapple with any of those decisions since it has not been determined that your husband had indeed suffered a heart attack. Hopefully it was just an anxiety attack or other malady and you will both be spared all the agony. At any rate, get all your questions answered and don't let them rush into doing something that is not needed. If his condition is stable, you have plenty of time to make a decision, get other opinions and follow the best course of action. Best of luck.

 
Old 08-20-2007, 05:56 PM   #4
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Re: Admitted to hospital & waiting for an angiogram

Quote:
Originally Posted by nikifairy View Post
Merrilly plodding our way thro life when all of a sudden my hubby (48) got taken in for chest pain. We've been told not a heart attack (from bloods) but he has to have an angiogram. Dr is now talking about a stent, etc but as he is still waiting to have the angiogram we are still in limbo. What will happen if he has to have a stent? Will he be able to have a normal life? So confused and worried, I'm 40 and we have no children - so scared of losing him. Any info from anyone who's been in a similar situation greatly appreciated.

Thnx
niki,

The usual protocol for chest pain is a stress test that views and records the perfusion of dye (injected into the blood stream) at rest and then with exertion. The evidence as stated(blood test, etc.) rules out heart muscle damage, in my opinion it would be wise to be medically treated before any risky interventional procedure. Medication can manage pain, reduce a the heart's workload, etc. There is very little risk of any progression if properly treated, and the blockage may never require a stent..

Because it is possible, if it is ischemia (lack of blood flow) due to coronary artery blockage, and if the blockage is less than 70% according to guidelines should not be stented, but treated with medication. If you go ahead with an angioplasty, it is almost assured the interventionalist cardiologist will implant a stent (more money), and it falsely justifies the intervention.

I have a completely blocked artery and a 72% blocked artery. A 98% artery was stented 3 years ago, and I had had a silent heart attack, and enlarged heart and mitral valve regurgitation. With medication, I have not had a bad day in 3 years, heart is normal size and functioning normally and regurgitation has been reduced.

Proceed with other tests (x-rays, EKG, echocardiogram) and if necessary a stress test before angioplasty. The test prior to angioplasty will determine if the heart is enlarged, heart wall motion and thickness, heart valve compliance, etc. and if necessary a stress test. Then decide whether to have an implant or not!

Last edited by started04; 08-20-2007 at 05:59 PM.

 
Old 08-20-2007, 07:55 PM   #5
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Re: Admitted to hospital & waiting for an angiogram

I agree with most of what has already been said. Yes, life can be perfectly normal after a stent is placed (had one put in almost 3 years ago) except for the medication he'll have to take and the lifestyle changes he will likely have to make (e.g. eating better, exercising more, reducing stress).

I cannot imagine why anyone would be doing an angiogram without first doing a nuclear stress test. If the nuclear stress test shows probable ischemia, THEN it is appropriate to do an angiogram. There are risks to an angiogram, including death, so it should NOT be the test of first choice.

The study that was referred to earlier that showed that medication and lifestyle changes were as effective as a stent had a major flaw: they did NOT allow many kinds of patients to participate in the study. For example, I would have been ruled out of the study because of the location of my blockage (LAD). So, you cannot take it on face value that medication and lifestyle changes are as effective as a stent for everyone. In fact, so many kinds of patients were ruled out that it may be a minority of cardiac patients for whom it is true that stents are of little benefit.

Best wishes!!! It is a scary time for both of you, I'm sure.

 
Old 08-20-2007, 11:32 PM   #6
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Re: Admitted to hospital & waiting for an angiogram

Thank you all so much for replying, I am just popping on quick before I dash to work.

I probably should have said - he has had a stress/treadmill test since being admitted, this is why they now want to send him for a angiogram. The ECG on the test came back with 'abnormalities'. From what I can gather, these show up when he increases and decreases exercise. It's really difficult knowing what questions to ask when you've not been there as I'm sure you all can appreciate.

Your words have helped me this morning, last night I was a bit down and in worry mode.

I'll keep you posted.

Thank you again for taking the time to reply to me.

All the best
nikifairy
x

 
Old 08-21-2007, 08:37 AM   #7
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Re: Admitted to hospital & waiting for an angiogram

Quote:
Originally Posted by nikifairy View Post
Thank you all so much for replying, I am just popping on quick before I dash to work.

I probably should have said - he has had a stress/treadmill test since being admitted, this is why they now want to send him for a angiogram. The ECG on the test came back with 'abnormalities'. From what I can gather, these show up when he increases and decreases exercise. It's really difficult knowing what questions to ask when you've not been there as I'm sure you all can appreciate.

Your words have helped me this morning, last night I was a bit down and in worry mode.

I'll keep you posted.

Thank you again for taking the time to reply to me.

All the best
nikifairy
x
Niki, for a perspective and referring to "show up when he increases and decreases exercise". Exercise increases demand for blood/oxy and because some heart vessels are narrow (blockage) there will be an inhibition to a good supply of blood to meet the increased demand. As a consequence this may/will cause chest pains medically referred to as angina...stable angina (pain only with exertion) and unstable angina (pain with or without exertion).

A non-interventional cardiologist would perscribe medicaion that opens (relaxes) the vessels permitting sufficient blood to the deficit area and treat the underlying cause. An interventional cardiologist is trained to implant stents the non-interventional cardiologist is not. My current cardio doctor is non-interventional and the prior doctor was intervention trained. He stented a 98% RCA and a few months later wanted to stent a 72% blocked artery even though I had no symptoms...he's history.

 
Old 08-21-2007, 05:16 PM   #8
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Re: Admitted to hospital & waiting for an angiogram

What drugs open up a 72 percent blocked artery? How are you treating that blockage , with lifestyle changes and medicine I presume..the question is how do you track how well that is working? Another angiogram? I worry about how I will be able to tell if my diet and exercise program is working...I have a few 30 percent narrowed arterys..how in the future can I tell how those arterys look without another angiogram ( which I don't want to do ever again...the last one a few weeks ago really hurt )?

 
Old 08-21-2007, 10:28 PM   #9
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Re: Admitted to hospital & waiting for an angiogram

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Originally Posted by Lutheran122 View Post
What drugs open up a 72 percent blocked artery? How are you treating that blockage , with lifestyle changes and medicine I presume..the question is how do you track how well that is working? Another angiogram? I worry about how I will be able to tell if my diet and exercise program is working...I have a few 30 percent narrowed arterys..how in the future can I tell how those arterys look without another angiogram ( which I don't want to do ever again...the last one a few weeks ago really hurt )?
Lutheran:
I would venture to guess that millions of middle aged people and some younger ones are walking around with blockages of 30% or more. Studies done on soldiers killed in action in the Korean and Vietnam wars showed extensive blockages in some of those soldiers who were in their late teens and early 20's. So the 30% blockage that you have is not bad but I do think you are doing the right thing by being proactive and nipping the problem in the bud. Even if you don't reverse that 30% blockage (which is hard to do by any method), you will stop any further progression of athrosclerosis and THAT should be your goal. The way you will know that it is working without undergoing another angiogram is by the way you feel and look. You will lose weight, you will look healthier, your overall cholesterol numbers will drop with HDL going up (hopefully), your blood pressure will drop with no medications (again hopefully) and you will feel good overall with much more exercise tolerance and fitness. In addition, there are many non-invasive tests done at your doctor's office that will monitor your progress.

In 1986 I had my first heart attack. The LAD was 100% closed which triggered the attack and I had a blockage of 70-80% in the RCA. The course of treatment was angioplasty (no stents) of the LAD. The RCA was left alone to be done at a later date since they did not want to risk another heart attack. I never went back to get the RCA angioplastied. Remember back then, angioplasty was in its infancy and they did not know as much as they do now. With diet and exercise, I managed to keep both those arteries open for 20 years; however, eventually the inevitable happened and the LAD closed again. Afterall, this was a diseased artery that was traumatized (that is what angioplasty does) and even with following good heart-friendly life-style, it did close again possibly by a piece of plaque breaking up or by spasm. The treatment this time was by doing a minimally invasive bypass of the LAD and stenting the RCA which was 90% closed. That gives you an idea what a good diet and exercise program will do since it took 20 years for the progression of the RCA blockage from 70-80% in 1986 to 90% in 2006. There was also an extensive network of collaterals that had developed in that area. The only medication I am on right now is a 325 mg aspirin, and it is my personal belief that unless there is a genetic or physiological problem, blood pressure and cholesterol could be managed without any medication in most cases.

Heart disease is a very formidable foe and it can destroy so many lives, but on the bright side, it is manageable in most cases and you can live with it a long healthy life if you are determined to learn and do everything that is needed to deal with it. Luckily, we live in the age of the internet where you can research and learn so much about it. Hopefully by continuing your aggressive lifestyle changes, you will never have to undergo that angiogram again. Of course, a little prayer and thanking God every day goes a long way to help us along.

 
Old 08-22-2007, 09:23 AM   #10
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Re: Admitted to hospital & waiting for an angiogram

Quote:
Originally Posted by Lutheran122 View Post
What drugs open up a 72 percent blocked artery? How are you treating that blockage , with lifestyle changes and medicine I presume..the question is how do you track how well that is working? Another angiogram? I worry about how I will be able to tell if my diet and exercise program is working...I have a few 30 percent narrowed arterys..how in the future can I tell how those arterys look without another angiogram ( which I don't want to do ever again...the last one a few weeks ago really hurt )?
Isosorbide medication targets the coronary arteries and widens, opens, dilates, relaxes those vessels...Lisinopril (ACE inhibitor) dilates system vessels providing relief to the heart's workload. It lowers blood pressure and slows or prevents the damage done by higher blood pressure to the vessels.

My cholesterol is normal at 144 mg/dl, but the doctor wants to lower the cholesterol to below 100. Recently, I was put on Lipitor and given the impression that will reduce and/or clean vessels. I have a lab and doctor appointment in Oct. and will know more at that time.

Nuclear magnetic resonance imaging (NMRI) can provide with a generated cross-sectional image of any plane or planes with minimal loss of image quality recorded in a 2D or 3D matrix and can provide info on the degree of vessel blockage, abnormal growth, etc...Angioplasy provides information on internal gradient pressures, used to take a biopsy, determine EF, and implant a stent, etc.

Last edited by started04; 08-22-2007 at 09:26 AM.

 
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