Did you have “Medical” or “Surgical” intervention for any Coronary Artery Disease and Heart Failure symptoms and how are you doing?

CAD and medical intervention

by AgentX86 - 2022-02-03 19:19:49

I had bypass surgery with pretty much a typical story for the US, anyway.  My Afib had just come back (after a seven year vacation) and I was way short of breath.  I'g go out in the yard and dig one small hole for a sapling (2yo tree) and after had hard time even standing.

My GP gave me a referral to a cardiologist who did a strss test, then a heart cath as soon as he could get me into a cath lab.  He was prepared to do a stent but the blockages were where he couldn't or wouldn't put a stent. I was then referred to a throacic surgeon for a CABG.

Nowhere was there any talk of drugs.  However, if the problem were "just" angina, drugs would certainly be appropriate. Any severe blockages are treated agressively from the start.

To answer your questions more directly.  Yes, I was given "choices", though I didn't really have a choice of stent vs. CABG.  It was a flow chart.  If stent = no ==> CABG.  No drugs were even discussed.

I've told my PM story but yes, I talked with my EP for months about a pacemaker as a means of increasing my antiarrhythmic dosage. When the serious pauses occured it became a moot question. Of course there were many discussions about the next step in my AF/AFL treatment with my cardiologist then EP.  When it got to the point of an ablation, I was referred out to an EP who specialized in ablations.

I also had a carotid "blockage".  My vascular surgeon gave me a direct choice, surgery to strip the gunk out of my arteries or a stent to hold them open.  I chose the stent.  Good thing because the CT-A lied and instead of 80%-90% blocked, they were actually something like 20%.  Because I went the stent route, I didn't have my neck hacked up for nothing. I still have an annual dopler sonogram on my carotids to keep an eye on them.

Yes, I've always had a long discussion with any doctor before any sort of precedure, discussing the alternatives (pain or death, in the case of the CABG) and exactly what was going to happen, how long I'd be hospitalized, and the probable recovery timeline. The down side was also discussed but there really wasn't one, in this case.

Even after the auto accident last summer, my orthopedic surgeon gave me three alternatives (leave it heal as-is, re-align and cast, or surgery with a plate and screws), and the probable short and long term results based on that  decision. He spent perhaps a half hour just going over the alternatives and a description of the processes.

Equal partner?  IME, always.  I'm sure others have had doctors who shouldn't be allowed near a dog (my brother was a veterinarian ;-) but my experiene has been great.  Of course I ask the referring doctor who they'd use if their spouse needed the procedure (and hope things were good at home ;-0)

CAD, Vtac, Afib, etc.

by Old male - 2022-02-03 21:09:39

To summarize:  At age 49 (24 years ago) strange feeling in lungs after developing a common cold.  Had a Chest Xray that was clear.  Referred to Cardiologist.  Failed stress test then Heart Cath found LAD severely blocked.  Also, found scar from previous heart attack I wasn't aware of.  They would not let me go home and scheduled Bypass surgery for the next morning.....5 grafts.  Recovered quickly as I had been actively exercising for years.  Six years later had arterial plaque rupture total blocking RCA....was out of town and ended up being a 12 hour event and helicopter ride to hospital.....received 2 stents.  Took most of a year for the extreme tightness feeling in chest to finally fade away.  A few years later, driving home from Gym one night suddenly had an about 1 second as if I had closed my eyes....but I didn't.  Scary feeling.  Happened again a few days later sitting in a chair.  Like I was trying to blackout.  Cardiologist had me wear a monitor for a couple of days.....discovered Ventricular Tachycardia and received ICD a few days later.  Has shocked me out of bad rhythm twice so far.  Diagnosed Heart Failure with EF 25.  Life goes on about 4 years then suddenly find myself short of breath rolling the garbage can to the street.  Well I learned what Afib was and tried 3 Cardioversions that didn't last very long.....now I just live with it. 

To answer the question, as far as any treatment options to discuss with doctors.  All I can think of would be Ablation for Afib.  But from what I've read, many are not long lasting cures and require additional procedures.  The thought of burning scars on my heart to go along with the other 2 from MI's is not appealing.  So, I will just continue to exercise, work and pray for the best....life goes on.        

AgentX86

by Gemita - 2022-02-04 08:25:42

Thank you for reminding me of your past medical history. I am assuming your CAD played a strong role in triggering your arrhythmias and then AF just made your heart condition worse.  It sounds as though you got excellent care, when you most needed it, with investigations looking for blockages from the very start to establish the cause for your symptoms.

Family members here found that medication never really helped with their angina pain as effectively as surgically restoring blood flow through either a partially or severely blocked artery.  In some cases Coronary Microvascular Disease was found to be the cause for their chest pain which has been more difficult to treat.

I was interested to hear about your Carotid artery that was found by CT angiography to be 80-90% blocked when in fact only minimal disease was present.  Cannot understand how CT could have got it so wrong, although I do realise direct visualisation with carotid angiography is the gold standard for imaging the carotid and cerebral vessels.

Equal partner?  Not so sure I or some family members always feel “equal partners”.  My husband is very fortunate to have a kind, caring cardiologist who will listen and believes in leaving well alone a lot of the time but my sister’s cardiologist is pushing yet more meds on to her than she can really cope with.  Her EF was down to 16% at the last count AgentX86 and frankly she seems better “off” rather than “on” some of her meds.  My concern is that so far she has not had the necessary investigations to know what has caused her sudden fall in EF and I am pushing for this to be done with some urgency now. 

Old Male

by Gemita - 2022-02-04 08:30:13

Thank you so much for your response.  You have certainly been through the wars too and have come out fighting, no doubt due in part to your excellent level of physical fitness despite your heart disease.  

It is always surprising that some of us can experience a heart attack or even a mild stroke without knowing and this is often picked up on imaging many years later.  It happened to my husband too - they found he had had several silent strokes.  My husband also suffered from Ventricular Tachycardia but it was essentially non sustained.  

I agree with your opinion about ablations, even though I haven’t had any, nor my husband, for our arrhythmias.  I do believe though that ablations can be more effective than medication, but of course they may not hold and then they may well cause or trigger additional arrhythmias.  Your recipe of exercise, work and spiritual healing sounds an excellent plan though Old Male and you have certainly proved that you have lived well since your bypass surgery some 24 years ago.  May I ask what meds you are on for your low EF/heart failure?

Gemita.....heart medications

by Old male - 2022-02-05 01:22:52

As requested, medications I take include:

Spironolactone 1/2 of a 25 mg tablet daily

Carvedilol 12.5 mg tablet twice daily

Propafenone HCL 150 mg tablets twice daily

Entresto 49 mg-51 mg tablet twice daily

I have taken these and other medications over the years and never had any noticeable side effects.

Gemita

by AgentX86 - 2022-02-06 17:29:17

I don't know if my CAD had anything to do with my AF because the AF came almost decade before CABG, anyway.  I had a maze procedure while there were tinkering around in there.  The theory is that the maze procedure is the definitive cure for AF.  Perhaps, and it worked, but it caused my AFL, too.

Evidently I'd had two "micro-infarcts" somewhere along the line that eventually cought up to me.  The guess is that that was what caused the siezure a couple of years ago.  It's also what caused my balance issues. It isn't serious but it causes me to look down when walking.  My neurologist says that it's because I can't trust my feet. Message to all: make sure you're religious with your anticoagulants and don't ignore arrhythmias.

The explanation for the CT-A discrepency was that the plaque is calcium rather than fat/cholerterol.  Calcium is far more dense so the CT-A was fooled. Neither are great, hence the annual dopler to measure flow/turbulance in the carotids.

To add to the paragraph about the auto accident.  I was just referred to a hand specialist. He also discused what he thought was wrong and the different ways to proceed.  I was with him for some time, too, and ended up with a steroid injection from my wrist up through the carpel tunnel.  Didn't help like he thought it would so we're back to more guesses or perhaps an MRI.

My thorcic surgeon didn't have much of a bedside manner but I wasn't looking for a friend. I only saw him three times, once before, once to wish me a nighty night, and once a couple of months after to allow me to return to work, drive, and all that. 

I once had a useless GP.  He doodled through the entire appointment. I didn't go back. Every other doctor I've seen had been excellent.

I do have a funny story.  When I was in college I had a fever that would build, tihen break in cycles.  When it would break, I'd instantly turn white as a sheet and get drenched in sweat.  I was in the student "health" center getting checked out.  A nurse was taking a blood sample when my fever crashed.  She was paniced and said "are you sick, or something?".  Even though I was sicker than a dog, I couldn't stop laughing.  I had mono. The doctors there sucked too.  They probably couldn't get a job anywhere else. It was a pill mill.

Old Male

by Gemita - 2022-02-07 13:00:27

Thank you for the list of your heart meds.  I see you are also on Entresto which is reassuring for my sister with heart failure who is on the same med.  I note your EF is 25% and that you have an ICD  (no doubt for both heart failure and ventricular arrhythmias).  

My husband has right sided heart failure with preserved EF and pulmonary hypertension.  Both these conditions are difficult to treat.  My sister has heart failure with a low EF of 16%, although she is beginning to feel a little better with the help of some of her meds, but not all of them, some of which she is struggling with.  I think they are trying to throw everything at her before going down the ICD/pacemaker route.

AgentX86

by Gemita - 2022-02-07 13:04:03

Thank you for your message and I am really sorry to hear you are still struggling to recover from the motor accident.  Hands are so delicate and the nerves, muscles and tendons can take a long time to heal.  I have been there too.  The fingers of my right hand are still stiff after my right wrist fracture in 2009 and development of complex regional pain syndrome.  I don’t suppose I will ever get full flexibility back.

Your final para. made me laugh too!  I thought I was the only one who could come out with statements like that, like telling hubby during a sepsis attack “you must be ill if you have lost your appetite”.  (Of course I didn’t know how ill he really was at the time).

I am glad you have had and continue to have excellent care overall, although I doubt you would tolerate anything less than the best.  My sister has just had a falling out with the Cardiac nurse because the nurse insisted she take all her meds for her heart failure, even though my sister felt they were causing debilitating side effects.  It is very difficult with heart failure to get the balance right.  They are now looking at radiation treatment as a cause for her sudden heart failure.  She was treated for breast cancer some years ago. 

I agree totally with paying attention to anticoagulation with arrhythmias.  They are so dangerous and like you with your micro infarcts, I feel sure that blood pressure and AF caused my husband’s four silent strokes, last one being a cerebellar stroke which they now believe is partially responsible for his dysfunctional breathing.