HEART DISEASE

[vikrambakshi]

Dear Doctor,

I AM AN ASIAN-INDIAN MALE OF 45 YEARS OF AGE-RESIDING IN U.K.
I HAD A HEART ATTACK IN INDIA IN MAY 2003, AND ANGEOPLASTY AND STENTING WAS DONE.MY LVEF CAME DOWN TO 32%.
AFTER THIS FIVE YEARS PASSED WITHOUT A SINGLE PROBLEM, THOUGH I WAS TAKING THE RECOMMENDED MEDICINES.

IN NOV 2008, I HAD A CARDIAC ARREST WITHOUT ANY WARNING AND WAS LUCKY TO BE REVIVED BY THE AMBULANCE TEAM.IN THIS PROCESS I GOT BRAIN INJURY ALSO.AFTER ONE MONTH I WAS DISCHARGED FROM THE HOSPITAL WITH ICD FITTED TO ME.MY LVEF HAS COME DOWN TO 21%.

I AM TAKING-ASPRIN/CARVIDILOL/CLOPIDOGREL/ATORVASTATIN/
AMIODERONE/RAMIPRIL/LANSOPRAZOLE.

MY QUERRIES ARE-
-WHY DID THIS CARDIAC ARREST HAPPEN.
-HOW DID THE LVEF GO DOWN FROM 32% TO 21% OVER FIVE YEARS DESPITE TAKING REGULAR MEDICATION.
-IS ICD ENOUGH SAFE GUARD FOR THE FUTURE
-WHAT DOES LIFE HOLD FOR ME REGARDING THE PROGRESS OF MY HEART CONDITION. WHAT NEW PROBLEMS WILL/CAN COME, ARE THESE AVOIDABLE.
-ARE THERE SOME MORE TREATMENTS-(LVAD OR CRT OR EECP)ETC.CAN THESE BE GOOD FOR ME
-IS STEM CELL TREATMENT RIGHT FOR ME.IF YES HOW TO GO ABOUT IT AT WHAT COST.

RIGHT NOW TODAY I STAY AT HOME AND FEEL NORMAL-THEN WHAT / WHEN WILL BE THE PROGRESS OR DETERIORATION IN MY CONDITION IN THE COMMING TIME.

WILL BE VERY THANKFULL FOR YOUR VALUABLE REPLY.


VIKRAM BAKSHI
TELEPHONE-
0044-121-3578424

[Cleveland Clinic]

To answer your questions:
1- Why did it happen? No one knows, but we know that people with low ejection fractions following heart attacks do suffer from sudden cardiac arrest frequently ( 6% per year) and benefit from placement of defibrillators. You should have received one 8 weeks following your heart attack and stenting procedure.
2- Don't know the answer. You may need a repeat heart catheterization or a PET scan to seen if your stent is closed off, or if new blockages have formed despite good medical care.
3- An ICD and good medical therapy: Your LDL should be 70, your systolic blood pressure should be less than 120 mm Hg, and you should have a BMI <25.
4- We can't foreseen the future, but only minimize your risk. This is done with maximal medical therapy, lfestyle and dietary changes.
5- All of those are only needed if your symptoms warrant them. If you develop CHF, than a BIV-ICD upgrade may be warranted. If it becomes refractory then an LVAD may be needed, but here we must say that this is a very invasive measure, and one that has an almost 50% mortality at one year. Used as a bridge to transplant it may be more useful, but once again severe refractory heart failure is usually the indication.
6- Stem cells are still in their infancy and may prove to be more useful in the future. Presently they will increase your ejection fraction by about 2%, and are unlikely to offer much symptomatic improvement.
7- Heart transplant may be an option in the future should you develop symptomatic heart failure, arrhythmias with ICD firings or refractory ischemia. I don't know the age cutoffs or wait time in the the UK, but in the US it is offered up to age 65 and the wait time is about 18 months.

[jak2009]

I am not a Doctor but a patient with a similar situation.  I am a 47 year old male from India.  I had my first heart attack when I was 39.  At that time two stents were placed.  One in the RAD and one in the circumflex.  My EF till 2006 (last echo before 2009) was 45%.  But in October 2009, I had a sudden cardiac arrest due to blocked LAD. Got stented.  EF went to 15 to 20% and found that the stents from 2001 were occluded.  This month had a triple by-pass surgery for the revascularization of my arteries (as stenting seemed to be a temporary solution for my condition), and a mitral valve repair that started to leak from october 2009.  I am now back home and recovering.  Feeling healthier than before surgery.  Do not know my EF yet.  The root cause of all of my cardiac events had been Smoking along with cholesterol, no exercise, and stress etc.  I stopped smoking after 25 years on October 2009.  Now in your case were you able to trace your heart problems to the main root cause.  Do you or Did you smoke?  How is your cholesterol?  How is your diet, exercise, stress, heredity etc.?  Medicines alone are seemed to be not enough.  Please feel free to ask any questions that I can answer as a patient.

[jak2009]

Hi Vikram,

It is pretty late for you now in UK.  Can you call me between 6 PM to 11 PM UK time?
I am in the pacific time zone (Seattle) in USA which is 8 hrs behind UK time.  My cell number is 001-425-533-7657.

The one key thing that is totally in our control is to quit smoking.  Have you now totally stopped smoking?  In terms of NYHA classification I believe we are in class II which is also referred to as Stage C in AHA classification.  Stem cell research certainly has good scope for people like us but according to many the benefits of this research may not reach us in the next 30 to 40 years that may be our life time.

Here are the steps I am following since my cardiac arrest in October 2009 and my by-pass in Jan 2010.

No smoking
No to excessive and undue stress
Medicines
Diet and
Excercise

[vikrambakshi]

HELLO.

SO THANKFUL TO YOU FOR YOUR REPLY.
I AM A CHARTERED ACCOUNTANT -BORN AND EDUCATED IN DELHI.NOW AM IN U.K
AND AM GLAD TO SEE THE SIMILARITY OF OUR MEDICAL HISTORY(THOGH NOT A PLEASANT THING). I TOO HAD MY FIRST HEART ATTACK AT THE AGE OF 38 (THANKS TO MY FATHER WHO DIED AT THE AGE OF 45 BY A HAEART ATTACK TO). IT WAS A SUDDEN EPISODE CALLING AN ABULANCE AND JUST MAKING IT TO THE HOSPITAL AFTER PROBABLY 5 HOURS OF THE BEGINNING OF THE DISCOMFORT. I WAS VERY LUCKY TO REACH THE HOSPITAL AND FINALLY STENT BEING FITTED TO MY PROXIMAL LAD.
THAT TIME THEY DID NOT FIT ANY ICD/ETC.( WHICH I NOW COME TO KNOW THAT IT SHOULD HAVE BEEN DONE).MY EF CAME TO 32%.
FOR THE NEXT FIVE YEARS I WAS ABSOLUTELY FINE AND EVEN FORGOTTEN THE FIRST ATTACK. WAS NOT VERY REGULAR WITH MY MEDICINES ALSO. TRAVELLING AND EATING A LOT AND SMOKING TOO.

IN NOV 2008- MY PUJABI BLOOD SURFACED AGAIN AND I HAD A CARDIAC ARRREST. MY HEART STOPPED BEATING AND HAD TO BE SHOCKED FOR REVIVAL.LATER I GOT BRAIN INJURY ALSO-AND FORGOT LAST ONE YEAR MEMORY.  AM NOW FITTED WITH ICD.MY EF IS NOW 21@. BUT WHAT I SEE IS THAT ONCE THE HEART MUSCELLES ARE DAMAGED IN A HEART ATTACK, SOME PROBLEM WILL KEEP SURFACING EVERY 5 YEARS OR SO.

-HAVE YOU DONE ANYTHING FOR YOUR HEART MUSCELLES?

-WHAT DO YOU THINK OF STEM CELL TREATMENT.

-TODAY I FEEL OK. BUT WHAT WILL BE THE PROGRESS  OF OUR CONDITION NOW ONWARDS. WILL IT GO BETTER OR WORSE.

-ARE WE IN HEART FAILURE STAGE I/II/III/IV.

PLEASE SPEAK TO ME ON THIS NUMBER-

0044-121-3578424

OR WRITE TO ME ON-
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SHALL WAIT TO HEAR FROM YOU.

WARM REGARDS.

VIKRAM BAKSHI