Cardiac Risks

What treatment for a heart blockage is best?

Question: 
I have been advised by my primary physician to schedule a cardiac catherization and possible stent placement procedure after having a Nuclear Stress Test with the following "Findings:  The study quality is excellent.  There is no transient LV ischemic dilatation noted.  The left ventricular chamber dimensions are normal.  There is a mild to moderately reduced perfusion defect of moderate size in the inferoapical wall.  Study quality: fair. SPECT images demonstrate normal perfusion at rest.  The left ventricular chamber dimensions are normal.  The defect in the inferoapical segment is reversible.  The left ventricular chamber dimensions are normal.  Normal systolic function.  The calculated EF is at 60%."  And the "Impressions:  1. Ischemia: There is a mild to moderate area of ischemia in the infero-apical segment(s).  2. Stress EKG: Stress EKG Test Results - Normal.  3. There is no previous study available for comparison.  4. No evidence of infarction.” DO I NEED THIS PROCEDURE OR ARE THERE BETTER OPTIONS?  

The test proves you have insufficient blood supply to a small part of your heart, but that overall function is normal. Many patients can be treated with medications and a heart-healthy lifestyle, and a procedure such as a stent or bypass is only needed for them when there are disabling and/or progressive symptoms, or the blockage is in a dangerous location.

The blockage is likely in your right coronary artery and treatment should depend on  your symptoms and the heart muscle section at risk. You can calculate your options here.

Hope this helps,

Dr T

Risk of a shock by a defibrillator while performing CPR

Question: 
I have a friend with internal defibulator. can I perform cpr and is it possible for me to get shocked if the debibulator is going off?

You are perfectly safe fro getting a shock yourself if an internal defibrillator fires during CPR. With an Automatic External Defibrillator stay clear when the device starts charging until after the shock has been delivered  and resume CPR afterwards until help arrives! Please read these links: 

http://www.cardiachealth.org/login

http://www.sca-aware.org/sudden-cardiac-arrest-faqs#faq10

Hope this helps,

Dr T

Eight failed stents in a row!

Question: 
i just had a heart attack again on the 19 of march 2016 they put a stent in me again to open up the flow this will be my 8th stent but now i am still having a lot of presure in my chest is that normal it is uncomfortible or is there something else going on  

Any recurrent chest pain after stenting indicates a very real risk of stent failure and you need to see your doctors immediately to get checked. Your symptoms are consistent with angina. Ask for another stress test or a 2nd opinion if your cardiologist refuses. You now have a long-standing and recurrent problem (stents) that fail! You can calculate the optimal treatment in your case here.

A high risk for a heart attack or stroke

Question: 
Your question: I am 73 and my recent (March) cardiac risk is 20 - what does that mean?  

It means you are at a high risk for a heart attack or stroke within the next ten years

Calculate your risks. 

Hope this helps,

Dr T

Help!

Question: 
I'm 61 and on my last visit to my cardiologist, he wanted to do a heart cath to see if anything was going on in my heart.  I had been to the emergency room 2X in the prior two months with high BP 200/110 on one occasion and 180/100 on the other.  In both cases my heart rate had increased to 120-130 at rest.  The ER found nothing wrong with my heart.  My EKG was normal, as it has always been, and a contrast CAT scan of my chest showed no abnormalities. (BTW, my older brother is treated for the same condition with meds). At my last visit we agreed that I would continue losing weight (I've lost 21 pounds.  I'm 6'1" and 192 now), cut out the fatty food and exercise more.  We would check my blood work in 3 months and consider taking statins.  My HDL is 43, my LDL is 119, my total cholesterol is 180 and my triglycerides are in normal range.  It sounded like a great plan. Two days after my visit I went back to a local ER because my BP and heart rate jumped again.  Again, nothing was found wrong with my heart. The next day, my doctor's nurse called and said that my doc would really like to do a heart cath to see if I have any issues.  I agreed, mostly because I have a bicuspid heart valve, which has no stenosis and mild regurgitation.  There is no heart disease anywhere in my family and so I expected that he would find nothing. Prior to entering the cath lab, I specifically asked to be awake for the procedure and to talk to my doc before we started.  Neither request was granted as the technicians  knocked me out and I did not get to talk to my doc.  Two hours later, I woke up with a stent in my Circumflex Artery that I did not want nor agree to for 70% to 80% blockage and no chest pains or symptoms. So, now I'm on all the meds, my chest occasionally has pain that it never had before and I'm worried sick about a blood clot and restenosis.    

You certainly have every right to complain: no doctor should perform a procedure w/o a pt’s permission, and it is questionable whether you needed the stent. While you have proven coronary artery disease with hypertension and overweight as risk factors for future heart attacks and/or stroke, your weight loss and excellent cholesterol data would have been reasons for me to focus on getting your BP under better control, helped by continued diet and weight loss: so called "Optimal Medical Therapy" has proven to be just as effective (if not better)!

It is impossible to tell whether these new chest pains are a result of the stent procedure, but they do fail on occasion, so you may need to be re-evaluated to check whether this has happened if your symptoms persist! Please read this post about the subject:

Scared to Death

Question: 
Can too much adrenaline cause a heart attack? Just read a story about a 79 year old who got scared to death by a bank robber.

Broken Heart Syndrome is a condition caused by acute severe stress  and a sudden surge of stress hormones.. Some potential triggers of a broken heart syndrome include:

  • News of an unexpected death of a loved one
  • A frightening medical diagnosis
  • Domestic abuse
  • Natural disasters
  • Job loss
  • Divorce
  • Physical stressors, such as an asthma attack, a car accident, or major surgery

If it occurs in someone with an pre-existing heart condition such as coronary artery disease it may well cause a fatal acute heart attack

Hope this helps,

Dr T

 

When CABG is your best option

Question: 
I am 57 years old, I eat a healthy diet, I have exercised for many years, I am a non smoker, etc. and have just recently had my first stent procedure (one more to follow soon). My brother had a quad bi-pass at 50 (he is a year and a half older than me) and my mom had stent procedures starting in her 50's and a heart valve replacement at 73. After seeing your video and article on stent procedures versus other alternatives I am now questioning whether or not I should have the second stent procedure versus pushing for the bi-pass surgery. What guidance can you provide in regards to my options? Obviously the healthier lifestyle is not the fix in my case.

A choice of CABG vs. more stenting depends on many factors as I have explained not only in my video but many times:

When coronary artery bypass surgery is your best option

How long does a stent last? 

Thus, in your case, your choice depends on (recurrent) symptoms, whether your stent fails, or whether you have other blockages (and where), what your heart function is and your general health. I don't have enough information for a specific opinion.

Hope this helps.

Dr T

Heart attack, emergent quadruple bypass

Question: 
Thank you for taking my question.  My father in law is 76.  Last Friday after experiencing chest discomfort he was brought to ER and immediately to the Cath lab.  The dr who did the Cath said he would have not survived the day had he not come in.  His EF was between 10% and 15%.  He needed emergent bypass that day.  He came out after having a quadruple bypass.  Tomorrow will be a week.  He is retaining fluids despite aggressive diuretic treatment.  His echo as of yesterday has shown no improvement in heart EF.  Still 10-15.   He has lived VERY healthy.  Just had a physical with EKG 2 wks ago. Passed with flying colors.  Never hbp Normal cholesterol, regular exercise, vitamens and a good diet with low weight, never smoked.  Nothing.  So my questions are...Can we expect his EF to improve?Should he see a cardiologist that specializes in heart failure?What are we looking at for him long term?My Mother in law is anxious to get him home.  Thanks so much for your time!!!!Chris
Hi Chris,
Improved heart function (as demonstrated with the Ejection Fraction) happens often if there was "viable but ischemic" heart muscle before the operation:
If the coronary artery bypass surgery (CABG) is proven  successful, not only for the grafts to work but in recruiting heart muscle that received insufficient blood supply before the operation (it is called "dormant").

Heart Valve Surgery Problems

Question: 
My father (60 years old male) had a aortic heart valve replacement surgery 5 years back. He has been taking regular blood thinner medication everyday. He has experienced some issues lately (1) He sometimes feel a bit itchy inside his chest area where the valve replacement was carried out. This is rare though. (2) He has trouble sleeping at night, wakes up about 3am and then he feels something heavy and strainous in his heart area, he feels ok once he gets up from bed and walks around but having this heavy feeling every morning is worrysome. Kindly advice if these are normal after effects after even 5 years of surgery and if these will last always.    

If your father were my patient, I’d want to make sure his new valve is still working properly, and exclude coronary artery disease and/or some form of heart failure . The following tests would help figure things out apart from a full consult (cannot do without a proper examination by a cardiac specialist): a chest X ray, EKG, echocardiogram, some blood tests and possibly a cardiac stress test.

Hope this helps,

Dr T

Thoracic Aortic Aortic Aneurysm Treatment

Question: 
Diagnosed after chest pain that the aortas too wide goin to my heart what are the risks and will i need surgery ive had echocardiogram and am awaiting appointment to see specialist  

If I understand your question you have a condition called ascending aortic aneurysm (Type A in the picture in this link). If too wide it needs a major operation to fix. The risks depend on your general health and whether other things need to be fixed as well such as coronary artery bypasses and/or a heart valve. Like with any other surgery your risks for this operation need to be weighed against the benefits: for your doctors to discuss with you!

Hope this helps,

Dr T

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