Angio pics of LAD and Circumflex

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Aldo
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Date Joined Jan 2006
Total Posts : 289
   Posted 2/17/2006 12:14 PM (GMT -7)   
 
Erskine, do you take credit cards via email? Ha ha ha
 
Monday I saw my cardio and explained the following to him:
 
about a month ago, I hit the tmill and after ~ 8 consecutive days of 2 miles at a moderate pace, the angina returned and is for the most part, is unstable. My BP went from ~ 125/70, to 155/95, in a matter of a few days and remained high (at rest of course).
 
I increased my atenolol from 50 to 75 mg/day. I stopped the exercise and the angina improved significantly. My BP is now down to previous acceptable levels. I asked the doc if the increase in BBs could "mask" possible restenosis. He said yes.
 
I asked if the hospital he is associated with, could or would perform any of the procedures to remove plaque from stents (rotoblade etc). He himself no longer performs any interventional procedures. He gave me the impression that "they" place another stent adjacent to and overlapping to some degree, with the older stent.
 
I fear I may be one of the unfortunate "stentees", because my blood lipids are so high and I continue to smoke. I also am a T2 diabetic, but BG is maintained fairly normal by diet. I am a member of the cardiac syndrome X club. I have all the requirements except for the 40" waist line.
 
I really don't know what to do next Tusday. Scan or cath. I have had 4 caths to date. They are a piece of cake. The doc told me Monday that I was past having any more nuke imaged stress tests. The rather massive rad dose from the scan is scary. I also fear another mi or stroke from the cath, due to plaque rupture during the procedure. I have had a light flavor of each, ~3 years ago. Is there any type of "filter" downstream of the plaque, or vacuum created in the area that they are dealing with?
 
I have an extreme fear of CABG, which is probably normal, but I have read and heard too much about it.
 
I do not want to burden you, nor take too much advantage of your much appreciated volunteer work here, but if you have a minute, would you peep at the angio pics? Is this the front left side of me heart? Thanks so much for your time.
 
RJ 

DREAMGIRL
Veteran Member


Date Joined Jan 2006
Total Posts : 600
   Posted 2/17/2006 7:07 PM (GMT -7)   
HI ALDO, SOUNDS LIKE YOU ARE HAVING A BIT OF A PROBLEM, I WILL BE WATCHING TO SEE IF YOU GET THE REPLY YOU ARE AFTER, I THOUGHT YOU WERE THE ONE WHO SAID YOU WERE ON A LOW CALORIE DIET AND YOUR BP WAS 90/60. I GUESS I HAVE THE WRONG PERSON, ALSO, ARE YOU FEMALE? GOOD LUCK I WILL BE THINKING OF YOU.

Aldo
Regular Member


Date Joined Jan 2006
Total Posts : 289
   Posted 2/17/2006 8:06 PM (GMT -7)   
Thanks for the good luck wish :) . I am male and my BP has never been that low! I missed the post you are referring to. I am lazy and do not read all the post here, lol. No, I do not really have the time, but I am going to try to do better in the future.

Kindest regards,

RJ

erskinej
Regular Member


Date Joined Jan 2006
Total Posts : 32
   Posted 2/19/2006 9:36 PM (GMT -7)   
Aldo,

First off, I do not accept payment here, as I am not seeing you as a patient, nor anyone else here--I am only offering advice.

Secondly, your pictures are nice (and yes, this is the front left side of your heart. The stent in your LAD is in the proximal part of your LAD and the LAD travels down the anterior surface, supplying most of the septum of the heart); however, your symptoms to me suggest that you have restenosis, unfortunately.

Personally, I would favor another cath. the CT is "almost" as good as a cath--but not as good, nor will it be anytime soon. In addition, the Xray exposure is more, and if there is restenosis, then you will have to go the cath route anyway, thereby increasing your xray exposure.

Filter wires only work on small vessels--not the aorta which is what you would want to prevent a stroke while doing the angiogram, so you are out of luck with that one.

In terms of rotablation, angiojet, and other therapies, they only work on special types of stenosis, and restenosis usually is not associated wtih those--so those would probably be out.

Hope this helps. Again, I am not posting to TELL you what to do, but to give you advice. And always, defer to your physician--who is treating you, rather than by some stranger over the internet.

Aldo
Regular Member


Date Joined Jan 2006
Total Posts : 289
   Posted 2/20/2006 8:23 AM (GMT -7)   
Erskine

I sincerely thank you for your information here. I know it is only advice, but I think it is d**n good advice, and more than I am getting from my cardiologist. I just called and cancelled the ct scan scheduled for tomorrow. I did this before I read your post above. The rad dose is prohibitive, and as you say, I will probably need a cath anyway. I guess I had entertained the idea that a scan would find my stents nice and clear, and that all this was in my head.

Now, I will depend on angina to overcome this 75 mg of atenolol, Imdur, Altace and last of all, nitroquick. I think the angina will be proportional to the degree of restenosis, not considering the affects of meds. If the plaque continues to increase slowly, and not rupture, I will have plenty of time.

I could ask just one more question, but I won't :)......Did the increasing BP influence your opinion? Oops and am I a candidate for CABG or more adjacent stents?

Geeze, I realize how stupid that last ? was. How could anyone tell.....even a doc.

Thank you from the bottom of my heart, and I think you are building good karma here :) If you are religious then G-d bless you richly.

RJ

erskinej
Regular Member


Date Joined Jan 2006
Total Posts : 32
   Posted 2/20/2006 11:32 AM (GMT -7)   
Aldo,
 
First, thank you for the compliments, but please remember, that I am making an educated guess/assumptions, and we all know what assume does. tongue    Seriously though, the increasing BP is not a real factor to me...more your symptoms raise the hairs on the back of my neck.
 
In regards to CABG, if it is just restenosis at the LAD site, I doubt they will consider bypass. for one, your distal vessels are fairly small, and the surgeons love great "targets" -- as they call them.
 
Also, if you want, please go to http://www.acc.org/clinical/topic/topic.htm#guidelines  , especially the guidelines on stenting. http://www.acc.org/clinical/guidelines/percutaneous/update/index.pdf   Now these guidelines are written by and for physicians, but are fairly well written and can usually be understood by laymen (asked my brother to look them over, and he could read them --and he is a lawyer, so any multi-celled organism should be able to <lawyer bashing here;) >  They are long, but are grouped into sections, so read only the sections you want to read. If you have any questions about them, post here if you want.
 
Again, I hope this helps. 

Aldo
Regular Member


Date Joined Jan 2006
Total Posts : 289
   Posted 2/20/2006 1:45 PM (GMT -7)   

OK now DocER, I am just rambling here and so that's that. I have taken enough of your time so no need to reply :-) I am starting to believe even more in my higher power, in receiving all this advice, when I needed it most.

I have not had time to read your links, but boy I will. I have "studied" the heart and circulatory system for almost 5 years, via the net. Still I know nothing at all. I know that in any profession, there is jargon that develops with experience. I used to be able to, during a crisis in the control room nono , communicate with my peers, very distressing observations w/o anyone else around understanding the urgency, less they were in my "group". We read much between the lines....because of the encrypted way we said it. I can almost read between your lines..I think I will start medical school, if I can pass the MACT, ha ha ha.

I loved the part about "surgeons wanting a large target area". Whew! That's a relief.....but an infarct in this area couldn't be so good, I don't think, so I guess it gets back to adjacent stents, or the dirt nap, lol. You have suggested what my confused mind needed to hear. The nuclear imaged stress test, that is. My mind immediately trashed this option when my cardiologist was really, probably just speaking in general terms, about me or my condition being past that. I take things too literally. So, I will probably call today or tomorrow and try to get one scheduled. A dang good idea. I think these test probably return false positives > negatives, from what I have read, sooo they seem to fail conservatively, if not accurate.....

Hey, lawyers need love too :) Ha ha ha. He should already have you a discount on your malpractice insurance. If not, disown him yeah .

I must say again, thanks so much and I hope you will continue here. There is so much not explained to us, the patients by our doctors. I think that knowledge is power, but in the case of heart disease, I don't know, ha ha ha. Fear, anxiety or stress brings on angina in me, much faster and more severe than exertion. I hope that others like myself, understand this. With your help though, I can have less anxiety. I may call you Docnitro.....

Have a great day. I must read some,

RJ


Aldo
Regular Member


Date Joined Jan 2006
Total Posts : 289
   Posted 2/20/2006 10:56 PM (GMT -7)   
What some great information Erskine. I am losing my ability to read, but will continue tomorrow. I think I opened Pandora's box of in-stent restenosis. It looks like angioplasty will do the trick. No wait....Do I also need the radiation? Ha ha ha. I read once where it is good, and once where it is bad. Maybe tomorrow, I will get a better picture of all of this and just call me Doc and say set me up one of these here procedures, lol.

I can and probably will call for the "outpatient cath" appointment tomorrow, and skip the stress test. There is more waiting involved with this vs entering through the ER, but I am patient (not). I have been nursing the nitro today and hoping for much less pain tomorrow, or I take the ER route.

Thanks much for the information. I got a late start at it tonight. It is very heavy. I need a lawer I think :)

RJ

erskinej
Regular Member


Date Joined Jan 2006
Total Posts : 32
   Posted 2/21/2006 11:23 AM (GMT -7)   
RJ,

Data is very limited on the use of radiation in patients with drug eluting stents. In addition, radiation has fallen by the wayside pretty much in most interventional labs. It takes a certain amount of time to irradiate the area, and the results were not much better than DES's, so why spend 30 minutes on irradiating a lesion, when you can just spend 30 seconds inflating a stent? Especially in cost-conscious hospitals, that was a no-brainer, so most places do not even have the equipment anymore for radiation.

Good luck. My prayers are with you.

Aldo
Regular Member


Date Joined Jan 2006
Total Posts : 289
   Posted 2/23/2006 7:33 PM (GMT -7)   

Well I just got in from the outpatient facility, or Heart Center. Much to my suprise and pleasure, both of my stents were clear as a bell. They found a blockage today, where my Lad taps off the Left main. My choice is CABG or a new type of stent. That was an easy choice... This stent is only made by J & J and is the Cypher for arterial junctions. That's not what they called the area, but it is discriptive. From what I have been told, it hasn't been used much. They are going to have the Cypher Rep come from Birmingham, and the hospital's stent specialist is going to install it next Thursday. Not too long ago, I would not have had a choice.

DocER, I have my angio cd, so I will get it on my little website soon, and I would like your second opinion :) They told me they could take my mamerywhatchyamacallit artery and attach it downstream of this blockage (CABG), which would still be up stream of the stent in my Lad. That could be down the road a bit. I think this blockage was ~25% closed, < 6 months ago. I think it is around 60% today. Boy I feel it too.

My wife was hospitalized yesterday for pneumonia caused by a pseudomonas/aspergillus lung infection. She either has to stay 14 days, or wear a cath where nurses could come to our home and inject some very powerful antibiotics and fungal medicine. Her Mother died of this. She was raised in a house with mold.

Gee I hope all of my friends here are feeling as well as they possibly can :) It's good to be home.

RJ

 

 


els
Veteran Member


Date Joined Oct 2005
Total Posts : 4031
   Posted 2/24/2006 11:55 AM (GMT -7)   
RJ, I am glad that everything went well with your procedure.  Please keep us up to date on your stent.  I am sorry about your wife, that is terrible and you certainly don't need the added stress.  My thoughts are with you.......
~elisha
 


Aldo
Regular Member


Date Joined Jan 2006
Total Posts : 289
   Posted 2/24/2006 2:20 PM (GMT -7)   
Thanks Elisha :)
 
I have been trying all morning to get a frame or picture from the angio cd. It appears that it will not allow that to happen....The angio pictures I posted from 6 months ago, came from actual pictures that I scanned into my computer. These moviesor fast moving frames are hard to decipher.....The camers rotates 180 degrees above you. It is confusing to try to see anything that is not blocked....even though you can freeze frame it. It makes it much easier when the doc makes a pic for you. He knows what to print!
 
I downloaded an MS Word Viewer, and I read the patient notes from the cd. I did copy those. I have a 70% blockage in my very proximal Lad. My L. main is very short. I hope that Erskine will read these patient notes and tell me what he thinks. Here goes:
 

The patient was brought to the cath lab in a fasting state.  The patient was prepped and draped in the usual sterile fashion.  Following subcutaneous administration of 2% lidocaine to the right groin, a 5fr sidearm sheath was placed in the right femoral artery,  A 5fr angled pigtail catheter was introduced via the arterial sheath and then advanced around the aortic arch into the left ventricle, an RAO ventriculogram was obtained.  5fr left and right Judkins catheters were then advanced around the aortic arch to obtain selective left and right coronary arteriograms.  The patient tolerated the procedure well without complications.

 

Indications: 

 

HEMODYNAMICS:

AO:  109/61 (82)

 

 

LV:   116/-6, 9

 

 

LVEDP:  9

 

 

 

 

 

LEFT VENTRICULAR FINDINGS:

Ventricular Function:

not noted

Valve Function:

normal

 

CORONARY FINDINGS:

Dominance:

 

Left Main Coronary Artery:

Very Short

Left Anterior/Diagonals:

Very Proximal/ostial 70%.

Mid LAD stent widely patent, mild distal disease

 

Circumflex/Marginals: 

Dominant.  Mild luminal irregularities.  OM1 stent widely patent

 

Right Coronary Artery:

 

Small, non dominant, 50% prox disease

 

Collaterals:

none noted

Renals:

Not performed

Aortagram:

Not performed

Peripheral:

Not performed

 

CONCLUSIONS:

 

Severe 1v CAD of ostial/proximal LAD,

Patent mid LAD and OM stents

Normal LV systolic function

 

RECOMMENDATIONS:

 

Case reviewed in detail with Dr. Hartley.  As left main appears short and ostial LAD may be spared, he is agreeable to attempt stenting.

Will d/c from THC today with tentative plans for PCI March 3, 2006.

 

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