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Old 10-20-2010, 04:10 PM   #1
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dan49 HB User
I have to make an important decision on some heart procedures.

First of all I have probably all ready made up my mind on what I am going to do but I wanted to get some different opinions and see if there is something I have not thought of.

The decision I have to make is live with a lot of angina for a long time and take a lot of medication or have another angiopasty ( which could be dangerous for me or go with a Carg (Heart Bypassy) or MIDCAB ( Heart Bypass but less surgery.

Here is the history:

About 10 weeks a go I started having heavy chest pains. I took all the heart test available they all came back normal. My BP was fine and my HR was normal. Talked to the Dr. and she said that they could do a angiogram on me but she did not think she would fine anything. I said yes because all my immediate family had heart problems.

The Dr. got me in the hospital started the procedure and found I had 2 blocked arteries at 98 and 99% in the LAD vein. The blockages were at a place where the main vien Y'd off the the blockages where right at the beginning of the intersection of the 2 veins. She put 2 drug coated stents in.
The procedure was only suppose to take 40 mins to an hr. but she had some complications getting in the stents and it took 3 hrs.

I was to be released the next day and I started having chest pains again so they kept me over night. Still having chest pains the next day so they extended it till the next day and moved me to a private room. So the next day I was to be discharged I was walking around some and got very dissy and neseaued agin with chest pains the Dr. came in and I told him what was going on . He said he needed to go back in. So back down to surgery and another angioplasty. He said he found the viens narrowed some and he balloned out the first one some more, but he said he could not get into the other vein. The stents were more or less protruding on each other. He said I would have some pains for a while and released me.

Went home for a week still having chest pains went back to the Dr. And she would not explain anything except to basically quit wining to I would have to live with some pain. Well I changed Cardiologists.

I went to the other Dr. and he examined my pictures for the surgery and he said he thinks he knows what the cause is. Apparrently one vein narrowed out some and that was causing my issues he thinks.

Here is my choices from him.

I an try to live with the pain and be on long lasting nitro ( which gives me very heavy headaches) and medicines and see if I can endure the discomfort.
Pains have steady in increased in severity.

OR have another angiogram which he said would be very dangerous due the fact the reason the other Dr. could not widen it out was the stents where in the way. So he would have to bleak through 3 walls of stents to get to the vein if was possible. He said in doing that he might loosen some plaque and send it into my heart or rupture the vein which I would then might have a heart attack.

Or Thrid Have heart by Pass.

All 3 have their pros and definite cons. My Reg GP suggested if I cannot withstand the comfort that He would probably say the Bypass is my less dangerous option. The Cardio Dr is will to do the angioplasty again but that would be some dangers. MY wife and I are leaning toward bypass.

I have tried to look at all the varibles but might have missed some would appreciate your thoughts.

 
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Old 10-20-2010, 07:34 PM   #2
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Vyking HB UserVyking HB UserVyking HB UserVyking HB UserVyking HB UserVyking HB UserVyking HB UserVyking HB UserVyking HB UserVyking HB UserVyking HB User
Re: I have to make an important decision on some heart procedures.

Hi Dan,
As you know Angina is the result of reduced blood flow to the heart muscle and the LAD is not something to take lightly it isn't called the 'widow maker' for nothing.

Since you are still having pain I would think you must still have reduced blood flow through that vessel.

As I said before in another thread .. Have the bypass, you won't regret it.
I know it seems scary but it's really not that bad.

Good luck with whatever you decide to do.

Last edited by Vyking; 10-20-2010 at 07:35 PM.

 
Old 10-21-2010, 07:27 AM   #3
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Re: I have to make an important decision on some heart procedures.

That is what we are leaning toward. I am going to try the long lasting nitro that the Dr. gave me to see if I can live the angina and try to hold off till the fist of the year. Beeen on the new med for a few days now it gives me horrible headaches. Now if I can put up with that. From what I know on my condition I might be a canidate for the MID CAB. It is suppose to be almost on the same as CARG except it is not quite as invasive.

Thanks Vyking.

Last edited by hb-mod; 10-21-2010 at 08:36 AM. Reason: Removed Quote. Please use "QUICK reply" rather than "QUOTE reply". Thanks!

 
Old 10-21-2010, 04:01 PM   #4
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Re: I have to make an important decision on some heart procedures.

Dan,
I have the following problems (questions) with your description:

1) If the pain is a constant one, it means that some areas of your myocardium are not receiving blood enough... the question is how long can survive that part of the myocardium in that conditions. Normally Anginas are intermittently.

2) If they placed 1 stent on each of the 2 Y shaped arteries .... then to go to the other part of the artery the Dr. only has to pass trough 1 stent not 3 as you mention. In your stent card you should have the diameter of them, just to get a feeling of the difficulty.

The fact that you have pain even after the first angiography makes me think that they did not placed one of the stents in the right place. Did they mentioned anything about particularly narrow arteries?? Why does it took so long?? Did you were awake? Did you hear any particularly tense dialog?

3) If they insisted that you will have no problem with your heart if you are able to support the pain ... it makes me think that the pain may not be ischemic related ... therefore how can they be sure that it will go away with the by pass?

Is the pain that you have now, similar but with lesser intensity that the one you felt before the angiography? If not, how do they explain it?

Finally, If Nitro gives you headache, there are other angina medications like Ranolazine that you can try.

Sorry, I am not sure if this help you or worry you more...

Good Luck

Jesus

 
Old 10-21-2010, 04:23 PM   #5
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Re: I have to make an important decision on some heart procedures.

Quote:
Originally Posted by jrueda View Post
Dan,
I have the following problems (questions) with your description:

1) If the pain is a constant one, it means that some areas of your myocardium are not receiving blood enough... the question is how long can survive that part of the myocardium in that conditions. Normally Anginas are intermittently.

2) If they placed 1 stent on each of the 2 Y shaped arteries .... then to go to the other part of the artery the Dr. only has to pass trough 1 stent not 3 as you mention. In your stent card you should have the diameter of them, just to get a feeling of the difficulty.

The fact that you have pain even after the first angiography makes me think that they did not placed one of the stents in the right place. Did they mentioned anything about particularly narrow arteries?? Why does it took so long?? Did you were awake? Did you hear any particularly tense dialog?

3) If they insisted that you will have no problem with your heart if you are able to support the pain ... it makes me think that the pain may not be ischemic related ... therefore how can they be sure that it will go away with the by pass?

Is the pain that you have now, similar but with lesser intensity that the one you felt before the angiography? If not, how do they explain it?

Finally, If Nitro gives you headache, there are other angina medications like Ranolazine that you can try.

Sorry, I am not sure if this help you or worry you more...

Good Luck

Jesus
Here is a answer to your questions there are some complexities to it so I shorted it some on the first post.

It is not a constant pain it does come and go with irregularity. Yes it is angina but is is starting to icrease in intensity.

The problem with t he placement was that both stent touch as the come out of both veins into the one vein. The Dr will have to go thru 3 sides of the 2 stents. They tried it once and could not get in there. The 2nd vein that is the problem was 99% blocked they thought they opened it up enough the first itme but they did not. Yes I was awake as are most angioplasty. Yes there was a concern of the dr when she was placing them it took here about 2 1/2 hrs on the 2nd vein to place stent.

They are no sure it will go away with the bypass but if I have another angioplasty it could be more dangerous than a bypass due to where the blockages where and how the stents where placed. That is why a bypass was even mentioned.

The pain is exactly the same the intensity is just less but growing agin that is why the dr said that the vein was already narrowed again.

No I am not worried about just have to try to make the best decision and then what happens happens. Hope I cleared up some of your questions .Thanks Jesus

 
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