Cardiac Risks

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Three vessel coronary artery disease

Question: 
Three vessels disease with 100 % RCA AND CX 90%,LCA95%
WHAT SHOULD DO WITH PAITENT AGE 65 yr
Plz give advise

In patients with extensive disease such as yours, by far the best solution is a coronary bypass operation if non-medical treatment is needed.

I have written about this extensively and hope reading this link will help you, Look at the results I achieved with my patients and make up your mind about what you think is best for you.

Hope this helps,

Stent and Failed Removal

Question: 
Prior to extensive surgery a stent was placed as a precaution to prevent clotting.  My surgery in 2011 went fine, but the stent could not be removed in 2012.  I’m scheduled to see the vascular surgeon who did the stent and failed removal.
What risks are there to leaving the stent in place?  I get the feeling that the sent could be removed but it would be more involved than simply “hooking” the stent and removing it as was attempted in 2011.
I feel fine.  I’m 38 years old and in good health.

Stents cannot be removed. Any surgeon who tells you it is just a simple operation is just wrong, certainly if time has gone by. If absolutely necessary, the segment of the involved artery can be resected and then replaced with an artificial graft. In general it is much easier to perform a bypass operation and leave the stent alone. 

Hope this helps,

A Bloody Pericardial Effusion

Question: 
My father was recently hospitalized with a pericardial effusion and atrial fib/flutter with a rate of 160.  Rate was decreased over 24 hours to 110-115 on amiodarone and diltiazem.  His cardiologist wanted to perform a chemical stress test.  (He had a negative cardiac cath 2 years prior).  My father felt that he was unable to tolerate the test, so he requested to speak with the cardiologist (who never came back to seem him).  Two days later, 750cc of bloody fluid was removed via pericardial centesis (needless to say by another cardiologist). My question is – Why would the cardiologist want to perform a chemical stress test on a patient who has a heart rate of at least 110 and who has 750cc of fluid around his heart?  Would this not be detrimental to the patient and what was to be gained from performing this test when clearly CAD was not an issue and the pericardial effusion SHOULD have been priority?

Good question, so why don’t you ask that cardiologists? When the pericardium becomes inflamed, the amount of fluid between the heart and the pericardium increases. This squeezes the heart and restricts its action and in his case, may have caused the AF/Flutter

Acute Stent Failure, Risks of MI or Death

Acute Stent Thrombosis frequently results in myocardial infarction (up to 80% of cases) with reported mortality rates between 30 and 45%. 

In contrast, Coronary Artery Bypass Graft occlusion may become apparent with recurrent angina, which then may lead to repeat revascularization. This effect is well known from the literature and did indeed translate into increased rates of myocardial infarction and cardiac death in the SYNTAX trial:

“CABG remains the standard of care for patients with three-vessel or left main coronary artery disease”(2)

Winning an Olympic Medal

When Coronary Artery Bypass Surgery Is Your Best Option

When is Bypass Surgery the Best Treatment?

The medical literature and my own experience support this course of action in symptomatic patients with known coronary artery disease:

Worried about life after a heart attack

Question: 
Hi, I am 35 and had a heart attack 18 months ago, due to high cholesterol. As a result I needed a stent in my RCA and have been told I have very mild disease in my LAD. my cardiologist told me I suffered next to no damage to my heart musle. My cholesterol is now under control. I was and am reasonably fit and have never smoked or been over weight.  I have had 3 normal stress tests since the MI. Can I live a normal life span if I continue to look after myself? and I experience the odd ectopic beat during rest and exercise which scares me. Should I be worried about ectopics? Thanks for your time 

You have a chronic disease called coronary artery disease (CAD), a complication of atherosclerosis. Although it is possible to slow down its progression, it is unlikely that it will stop and/or disappear. In addition you have a stent, which has a 10-15% failure rate and of course will not protect you against other blockages such as the one in your LAD if it gets worse.

Abnormal Holter test results

Question: 
My husband is 66 years old, 6”4′, 247, has high blood pressure & gout. Otherwise healthy. just got back his Holter monitor today. We have the test results, but his Doctor appoint is 3 weeks away. He was in sinus rhythm all the time. He had a minimum heart rate of 53 beats per minute and maximum heart rate of 142 beats per minute with the average heart rate of 82 beats per minute. He had 12,283 ventricular ectopic beats and 3 supraventricular ectopic beats. He had 1 episode of nonsustained VT with a run of 3 beats at a rate of 106 beats per minute. He had no runs on nonsustained SVT. He had 55 ventricular bigeminy episodes and 647 ventricular trigeminy episodes. He had no pauses greater than 2 seconds. The patient reports no symptoms on his diary. He had a regular exam his Drs. office. They did an EKG on which then processed to the Holter monitor. Question is should he have his regular primary Dr. follow-up or should he be seen be a heart specialist. He has no symptoms. Is this just going to be something to watch or is it serious? 

Re: “He was in sinus rhythm all the time”, he was not, hence all those arrhythmias.

Your husband needs to be seen by a cardiologist and be evaluated with a number of tests that include a Cardiac echo,  and a Stress test for “dangerous” arrhythmiascoronary artery disease and/or a poor heart function. Not every patient has symptoms!

Hope this helps,

Choosing the best procedure

Question: 
I proactively requested a stress test, at 66, due to not having had one in 10 years and my sister just had emergency CABG, possibly with genetic factors causing the coronary artery disease. Stress test completed, problem found, angiogram done 2 days ago.  Two blockages, 90%-95% occlusion of LAD near bifurcation; 75% occlusion of an artery on right side (don’t remember name).Dr. did not put in stents, wanting me to have choice of stents or CABG.  Told son ‘I have enough of a landing-zone to successfully put in stent’.  Will not make a recommendation, except to say CABG gives the better long term result.No other known health issues except hypertension treated for 5 years with Benazapril 40mg.  Lost 20 lbs in 2014, need to lose 20 more.  Rather sedentary lifestyle.. but will change that, of course.After talking to cardiologist and surgeon, I am more confused than ever.  I don’t know which procedure to choose??  Risk factors do not seem to be much different, based on 5 year numbers in the studies discussed by cardiologist and son (biologist/scientist, PhD).I don’t know what to do!  Last night I had the first angina episode…. took nitro tablet and it pasded, but I was just talking with family, not exerting myself, so I think this means ‘unstable angina’ now… 

Stents have a 10-15% failure rate in the first year of implant when the cardiologist judge it is an optimal situation. In your case, if a procedure is indicated, you will be much better of with a CABG. I have written about your situation here: How long does a heart stent last? Do they need to be replaced?

Contrary to what you heard,  there are significant differences between stents (PCI) and CABG. Here is a review I wrote for medical professionals: CABG Superior to PCI in long-term treatment of coronary artery disease

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