Having Coronary Angiography and possible Stent

Spent last Sunday night in the ER after experience chest pain and shortness of breath while watching TV. Paramedics said my BP was 202/98. They did the whole protocol for heart attack patient. Multiple EKG's and blood draws, chest x-ray, IV morphine, blood thinners, oxygen. Then I stayed the remainder of the night in the cardiac observation unit (still part of ER so not admitted to the hospital). In the morning they determined my EKG's remained normal as did my blood work so no heart attack suffered. I'm still glad I called 911.

I had a Myocardial Perfusion Imaging Scan on Monday (at rest) and Tuesday (Lexiscan stress). Results indicate possible area of my heart that is not receiving adequate oxygenated blood. It involves my Right Coronary Artery and/or Circumflex artery. Eleven years ago I had angiography after a false positive stress tests with scan and they only finding was 10% narrowing of the Left Anterior Descending Artery (the "widowmaker" if it becomes clogged). So I am having coronoray angiography on Wednesday, Jul 16 with possible placement of stent. Best case scenario is they find no significant narrowing and I won't have to worry about clogged arteries for another 10 years. Next best is they find moderate narrowing but not bad enough for a stent so we watch and wait. If they put in one or more stents, I will have to be on Warfarin (blood thinner) for a full year to prevent stent from clogging.

Any one have personal experience with stents. A lot of negative published information available on the web are 5-10 years old and involve procedures done 15-20 years ago. These old publications indicate problems with stent restenosis requiring multiple procedures over the 5 years following stent placement. Paints a gloomy picture about stents that I believe is unwarranted.

Stents aren't a big deal these days -the slit is about 1/4" or less in length and they don't even suture it. It's thirty minutes in the surgical theater followed by several hours of recuperation on your back in the hospital bed (they offer a pain killer,if you ask for it), then you go home with an icepack on your groin. Don't do anything too physical for a week or so. You'll be fine if you get the procedure.

Well, let's hold out hope for good outcomes of the tests without need for intervention. Neither I nor anyone very close to me has had a stent, but several acquaintances have. The only one who ran into trouble afterwards was the one with a clotting disorder that started their whole problem, not narrowing alone. Now that you've mentioned it, it dawns on me that the others haven't had any issues since and I'd forgotten they'd even had it done. Wishing you well.

I had two stents put in 2005, after a heart attact, then 1 month later a quad bypass, then 1 year later a defib implant with defective leads.

I take Plavix 1 tab daily, and 1 81mg aspirin, daily lab tests twice a year, still ticking. My heart output is only 35% at best. Jim

I know a number of people who have had this done, with and without stenting... all had good results, and are still ticking along. I have some mild carotid stenosis, so far the docs are just watching it, but the minute they tell me it's time to do something, I'll do it; if I don't I'm headed for a stroke, most likely.

Goofproof wrote:I had two stents put in 2005, after a heart attact, then 1 month later a quad bypass, then 1 year later a defib implant with defective leads.

I take Plavix 1 tab daily, and 1 81mg aspirin, daily lab tests twice a year, still ticking. My heart output is only 35% at best. Jim

So the stents placed in 2005 didn't do the job and you had to have quad bypass? 35% Ejection Fraction is Heart Failure. Not Good. Is that from your infarction. My EF = 50% which is just below normal. Normal is 55-70%. Less than 45% is considered heart failure.

VikingGnome wrote:

Goofproof wrote:I had two stents put in 2005, after a heart attact, then 1 month later a quad bypass, then 1 year later a defib implant with defective leads.

I take Plavix 1 tab daily, and 1 81mg aspirin, daily lab tests twice a year, still ticking. My heart output is only 35% at best. Jim

So the stents placed in 2005 didn't do the job and you had to have quad bypass? 35% Ejection Fraction is Heart Failure. Not Good. Is that from your infarction. My EF = 50% which is just below normal. Normal is 55-70%. Less than 45% is considered heart failure.

They did the stents and sent me home to die or get better, I was to far gone to work on. After a month, they did the quad. My rate has been 35 to 40% from 2005. After the stents I was walking 6 blocks, after the quad I can only walk 50 feet, I have to sit and catch my breath, adding O2 doesn't help, its like the plumbing is hooked up wrong. Now my heart is missing beats, they tested it last month, and said it's to be expected due to all the damage. Unless I pass out, they say live with it. The Defib unit has a pacer built in, but with defective leads it doesn't kick in. It's 8 years on the same battery, I guess they last longer ifthey don't work.

I think when they decide to change the battery, I'll have it removed, I don't think my heart can pump past a second set of wires, and what I now know about defibs I wouldn't let them install one, now a pacer if you need it, that's another deal. Even if it works a defib only gives you a 35% chance to get to a hospital. Stents are good, and fairly safe, compared to the alt. Jim

Doc rejected doing stents on me because they did not do more the two at a time in those days. A few days later, on November 15, 2001 I had a quad Bypass. The statistics say that doing a bypass has a better outcome than stent. I did really well when I had a stress test, with a full scan which said my heart was normal in 2001. My brother has had so many stents I do not know how they find room to thread another in there. His worst problem was when he had his first stent, VA hospital, and no one told him, or gave him a prescription for anticoagulants, led to his having a seizure. Flipped a clot, caused a stroke. Result, multiple brain seizures. VA was furious because he went to a normal hospital for treatment when he should have made an appointment to see them two weeks later for the seizures, and wanted him to pay the cost for the ER visit to a regular hospital. Although the VA hospital was an hour away.

Five weeks ago my brother had angina problems after working hours in the Texas heat. Ambulance took him to our rural hospital, then life flighted him to a larger facility, not VA, fifteen air minutes away. I went to visit him that night, where he had a huge headache from the drugs to keep his arteries, capillaries dilated. While there I shook his hand, his grip was so strong that he nearly broke my hand. He has not been sitting around during all these years. He worked outside today until the temp got to be 98 or so. Moral of his story. Seek medical care early. Angina pain is not a death sentence, neither is a heart attack. You can have a great and active life if you seek help quickly, do what the doc says. Even if they mess up big time and give you a stroke.

I had stent some fifteen months ago. The doc who put it in said, that he did not think it would make much difference, as the capillaries after it were probably closed off more. He put it in when I promised to faithfully take the anticoagulant every day for a year. I had great results. My capillaries were probably not so closed off, probably because my initial problem was Vioxx. My Blood O2 used to be like 94, and now is 96 to 98. I used to walk nearly as slow as possible on my treadmill, within three weeks after the stent insertion, I could easily walk at 3 plus on the treadmill for ten minute periods. I have arthritis, diabetes and walk on the treadmill to reduce my insulin resistance, thereby reducing my blood glucose. The exercise is clearly such a small amount that I am NOT burning off the sugar, but it is enough to open the gates for blood sugar to get into my muscles.

The down side. in the first few weeks Plavix scared me. Seemed like my blood was too thin, and I had to have a styptic pencil to stop the bleeding when I shaved. Then I thought it was not thinning my blood enough. Plavix was not cheap. Plavix caused my gums to recede from my teeth, so I have to floss after every time I eat.

The larger down side. Some of the hypertensive drugs, and cholesterol lowering drugs cause to help me to be diabetic. I say I am a pharmaceutical induced diabetic. Diabetes is an ugly, life quality consuming disease. BTW if you get a beta blocker, missing one dose can cause "rebound". That is if you miss a dose ones blood pressure does not go to the level which you had without any drug, it goes much higher. Causing strokes and heart attacks.

I am more fully awake now after the stent. I have finished the time period when I need to take the Plavix for a drug evoluting stent. Because of some strange symptoms, I am to have a Cardiac Stress test on July 31, as part of a regular check up in seeing my Cardiologist, but I seem to be stable.

Anyway. One should listen to the advice of ones docs as to which to do. I favor being pro-ACTIVE in doing procedures. I have a lot of things I still want to do in my life, and I now have a bit more energy to do some of them.

The Physical therapy one is advised to do after a procedure (stent or surgery) can make a huge improvement to ones health. Do all the supervised Rehab therapy you can get or can afford.

While I was talking to my Cardiologists nurse, she was telling me that since she came into working in Cardiology, she had come to believe strongly in sleep apnea treatment. Nearly all their cardiac patients had sleep apnea, and successful treatment of sleep apnea made a huge diff in the quality of life, length of life of their cardiac patients. BTW, I went to see my sleep doc after the stent to do another sleep study, (actually to qualify for medicare payment of a Bi Level machine) and the new machine has made another improvement in my overall health.

I know my heart likes deep rest, and at least a little exercise. I know that inflammation plays a big part in heart disease.

Best Wishes. and your mileage may vary.

If I am wrong in any thing I have said, I hope someone will jump in and point it out.

An elderly friend has had over 20 stents (he says; I've never known him to be untruthful or to exaggerate; but it seems like a large number). He told his cardiologist no open heart surgery; if it comes to that, he'd rather die. Cardio-Doc says he doesn't know anyone who has more stents. He's 88 now, and in great shape; sharp as a tack. A couple of them have occluded over time, but there is a laser procedure to clean them out if they do. He says it's the only way to go. Short procedure, he's back on his feet in a couple of days. But not everybody is a candidate; you really need to talk it over with your cardiologist.

VikingGnome, if I was in your situation I would be looking for S9 VPAP Adapt machine.


Adaptive servo-ventilation in heart failure patients with sleep apnea: A real world study

Peter C. Hastings
The following is not a link:
http ://www.internationaljournalofcardiology.co ... 0/fulltext

Abstract

Background

Congestive heart failure (CHF) patients often present with obstructive and central sleep apnea occurring concurrently within the same night. This study assessed the efficacy of, and improvements associated with, the use of adaptive servo-ventilation (ASV) in CHF patients with all types of sleep apnea. We hypothesized that ASV would be effective at reducing sleep apnea and improving both cardiac status and quality of life.

Methods

Eleven male patients with stable CHF and sleep apnea (apnea/hypopnea index (AHI) >15 events/h) were treated with 6 months optimized ASV and compared to 8 patients not receiving ASV. At baseline, both groups were comparable for New York Heart Association class, left ventricular ejection fraction (LVEF), plasma Brain Natriuretric Peptide (BNP) concentrations and AHI. All patients were receiving optimal medical therapy.

Results

At 6 months ASV significantly reduced AHI (mean (SD), baseline 49.0 (35.1) v ASV 7.6 (14.6); p=0.001) and LVEF was increased (median (inter-quartile range), treatment group: +5.7 (1.6–9.5) v comparison group: −4.0 (−8.9–+4.6)% respectively; p=0.04) but not BNP (p=0.59). The energy/vitality score of the SF-36 quality of life questionnaire was also improved at 6 months (treatment group: +10 (5–35) v comparison group: −12 (−18–+10); p=0.005).

Conclusion

ASV effectively reduces all types of sleep apnea. Six months of use is associated with improvement in LVEF and aspects of quality of life.


p.s. most of above posters have not mentioned their ages and/or genders. It's a pity.

I'm male, now age 70. I had one stent, one balloon therapy, and one "watch list" heart procedure 4 or 5 years ago. 2 years later the "watch it" blockage closed down enough to need stenting. No adverse side effects whatever from the stents or plavix and aspirin regimen. I do bruise and bleed easier but hasn't been a significant problem.

My doc said that no one he knows has died from a heart attack once they are on plavix, aspirin, and a statin.

idamtnboy, why are you not on VPAP Adapt? Aren't APAPs contra indicated by the Am academy for sleep medicine to be used by Cardiac Insufficiency folks?

avi123 wrote:idamtnboy, why are you not on VPAP Adapt? Aren't APAPs contra indicated by the Am academy for sleep medicine to be used by Cardiac Insufficiency folks?

Why should I be when my CPAP therapy is working quite fine?