Is This Normal Practice The World Over? - Heart Disorders Message Board

Xenyth · 10-08-2007, 07:40 PM

Hi All Im new To The Board So I do Have a Question

Ide like to know if the following is normal practice world wide.

Coming upto three years ago I suffered a small heart attack, If a heart attack can be catagoratised as small. It did little damage to the heart wall being only partial thickness as Im told, and doesnt show up on an ECG.

I was admitted to hospital where blood tests showed ide had a heart attack. I spent 3/4 days in coronary care and a few days on another ward. The following week I had an angioplasty where they found a blockage and did a stenting procedure, and another artery that was 50/60% blocked which they left alone.
I was released to go home the following day. I was put on a regime of tablets asprin, ramapril, atenolol, and simvastatin, and given a GTN spray to use if i got any chest pain. Six weeks later I had a follow up with a cardiologist and was discharged.

My question is, is it normal to have a heart attack?, have minor surgery, put on a drug regime and then discharged untill god forbid I have another heart attack or start again with chest pains?

I find this quite bizzare that in this day and age that this is whats the hospitals do, if its the norm worldwide then so be it but in my humble opinion I would think and hope follow up even if there a year apart should be done.

I ask this question mainly as I have already stated I have a partialy blocked artery and for close to three years now Its always in the back of my mind that this could errupt at any time causing another heart attack that in effect could be avaoided if a standard of checks were in place.

You thoughts and answers will be greatly appreiated and I appologise for the lengthy post.

John

huckfinn · 10-09-2007, 10:28 AM

Hello John

I can surely relate with you on this subject, but unlike you, I have not had a 3 year period of being out of the hospital. My longest hospital free period was 14 months. I have 5 stents now.

So I guess that I do understand this kind of "hands off" approach to heart or CAD patients. Although, don't get me wrong, I still have periodic appointments with my cardiologist. I have to in order to receive my medication.

If you are symptom free, they will not ask you to come in for coronary imaging studies of whatever kind. Nor will they say, "let's do another cath and see how that 50-60% blockage is doing. It may be 99.99% blocked now". This is the point I most agree with you on. You have a possible sudden cardiac death (SCD) situation (maybe?) but I very much doubt it. Most people are warned by angina when the blockage needs attention.

I have a blockage now also but cannot tell you what % it is. Last I heard it was 35-40%. I have to have bypass surgery when it grows up

Seraph · 10-10-2007, 01:10 AM

Quote:

Originally Posted by Xenyth

Hi All Im new To The Board So I do Have a Question

I ask this question mainly as I have already stated I have a partialy blocked artery and for close to three years now Its always in the back of my mind that this could errupt at any time causing another heart attack that in effect could be avaoided if a standard of checks were in place.
John

I think what you describe is pretty much normal treatment all over. Certainly here in Australia. The only way they can really check your coronary arteries is by angiogram and this is so invasive, expensive and complicated that they will not do it under any sort of public funding unless and until you become symptomatic (angina attacks, etc). You are with the general populace with your cardiac risk, in other words, most people are living with that slight risk of a random cardiac event. This is no comfort, but the medications you are taking are certainly reducing your chances of a repeat heart attack. I wish you the best. Sera

started04 · 10-10-2007, 10:43 AM

Hi John,

The usual protocol for heart attack patients is an echocardiogram (ultra sound feed back) periodically unless your doctor is an intervention cardiologist who likes to do angiograms.

My experience is almost identical to your situation. I had a heart attack 3 1/2 years ago and was in ICU for 4/5 days with congested heart failure. I have been on medication since, no problems, and I have an echo test yearly. EF is normal, but I do have a valve problem.

A "minor" heart attack can sometimes just stun heart cells, and with a timely supply of oxygen can revitalize the cells before there is necrosis of the cells.

An ECG or EKG, is insufficient for a follow up. Required is an ECHO to monitor heart chamber size, heart muscle movement, heart blood flow, the calculation of the EF (normal is 55 to 75%) is the fraction of blood pumped out with each stroke and sometimes fractional shortening (calculates the relationship of chamber dimensions).

With medication, my heart size is now normal, EF is normal, and it appears to be very little heart muscle movement or impairment that would indicate muscle damage.

Medication for me is an ACE inhibitor and beta blocker that lightens the afterload for the heart to pump against (relaxes vessels) and aspirin to help prevent clots, etc.

Perry2 · 10-14-2007, 03:34 PM

It takes a long time for blockage to get from 60% to 90%, Keeping in mind it took you several decades to get to 60% and presumably you are now more cautious about what you put into yourself.
50% of the untreated over 40 population in the western world probably have 60% blockage so it is too many to monitor, especially given the outrageous cost of Angio and stenting(I think $4000 just for the item itself which has no moving parts is likely produced for less than $100.00.) There may be a lifespan for the procedure as well which would mean they need to do it as late in life as possible.
What you are describing is the protocol in Canada as well. I believe they ignored a 75% blocked artery in my mother's heart when they stented a blocked one and she is a smoker. If you take care of yourself, no smoking, the right foods etc, I doubt your heart will ever get to the very high blockage that requires treatment.
I suspect there may be a movement within the medical community to place a high duty on the patient to prevent a relapse and that given most heart issues provide you with some alarms before it is too late, they prefer to wait for those alarms.
I will ask my cardiologost what the popular excuse for this when I see him next. Maybe there is just too many bad hearts out there. Even at the ridiculous price of $4000 it might pay to show up with your own stent and tell them to throw that in wherever they are planning ignoring a blockage