Aa
Chest Pain
I had two heart attacks at the interval of six years. There was chest pain immediately before attacks both the times. I did not have chest pain as symptom of heart disease. Even after heart attacks after medication I did not have chest pain. Angiography shows blockages in all coronary arteries to the extent of 90%,70% and 60% at the beginning. There are some blockages in the middle and at the end too. Inspite of so much blockages I do not have chest pain even on exercise. I am on medicines only. I feel my heart attack may be due to spasm of artery. But how to know?
ed34 - yes what you said is perfectly in order. While going for bypass risk benefits will have to be properly stated and balanced. Alternate source and risk involved in providing that will have to be looked into. Long term advantages and disadvantages of bypass must be taken into account. Bypass should not be temporary relief. It is very complicated matter not to be left to the medical professional only where interest may be money rather than patient's welfare. On paper patient's welfare sounds better. Pratice may be different. Proper evalution is must. That requires intelligence and degree only is not sufficient. degree is minimum standard. Thank you very much for enlightened discussions.
Yes there are a pair of carotid arteries in each side of the neck I believe, but at a cellular level it is very different. Tissue cannot get oxygen from an artery, the artery wall is far too thick and the red blood cells would have to be in contact with the artery lining all the time for gas exchange to occur. Eventually our arteries turn into tiny capillaries. These are thinner than a hair, and even red blood cells can only enter in single file, and they are squeezed so more surface contact is made. Only in these capillaries can oxygen be taken for cells. Collaterals are tiny arteries, but the walls are too thick for gas exchange and the lumen is too wide for red cells to give up oxygen anyway. An artery has to connect to a capillary and then a vein for the system to work. This would mean that collaterals cannot directly feed cells, all they can really do is link two arteries together, which makes more sense the more I have been thinking about it.
I recently read an article where a patient had a totally blocked LAD and LCX. The RCA had supplied collaterals to feed those 2 vessels distally, so well in fact that stress tests produced no discomfort. Cardiologists debated heavily on whether to intervene or not. The conclusion was to perform bypass surgery because he was relying on just one vessel to supply the complete heart. If the RCA formed a clot, then ALL the arteries would dry up.
This is why I had my LAD opened, the more sources, the higher the chance of survival.
I recently read an article where a patient had a totally blocked LAD and LCX. The RCA had supplied collaterals to feed those 2 vessels distally, so well in fact that stress tests produced no discomfort. Cardiologists debated heavily on whether to intervene or not. The conclusion was to perform bypass surgery because he was relying on just one vessel to supply the complete heart. If the RCA formed a clot, then ALL the arteries would dry up.
This is why I had my LAD opened, the more sources, the higher the chance of survival.
ed34 - Just like willy's circle in brain. Every cell may probably be fed from two supplies for more security and safety. We have two eyes. Alternate path to supply blood in case first path is blocked for some reason. This may be at cellular level. I am lay man from the knowledge of medical science but having strong common sense. My wife had one carotid artery blocked and that side of brain gets blood supply through willy's cicle from healthy artery of other side.
"But I am referring to collaterals that provide an alternate source of blood supply to myocarial muscle jeopardized by the occluded coronary vessel and not a bridge to the occluded vessel"
Do you have a source for such vessels? I have always been told that "we all have collateral vessels which are normally closed. They open in some people when blockages form, but not in everyone, and more open in some people than others and some are larger. The collateral vessels link different coronary arteries together, or different sections of the same artery". I have never heard of collaterals feeding directly into cardiac muscle? Would that not mean we would all have to have a much more complex system with capillaries and veins on the other side to take that used blood away? Without capillaries, collateral feed to any tissue would be pointless.
I have seen pictures of high collateral development in the brains of Mice, and they all link one artery to another, or one part of the same artery to another. None just go into brain tissue and come to a dead end.
I look forward to your source because it's good when you can have a conversation with a Cardiologist and prove them wrong :)
Do you have a source for such vessels? I have always been told that "we all have collateral vessels which are normally closed. They open in some people when blockages form, but not in everyone, and more open in some people than others and some are larger. The collateral vessels link different coronary arteries together, or different sections of the same artery". I have never heard of collaterals feeding directly into cardiac muscle? Would that not mean we would all have to have a much more complex system with capillaries and veins on the other side to take that used blood away? Without capillaries, collateral feed to any tissue would be pointless.
I have seen pictures of high collateral development in the brains of Mice, and they all link one artery to another, or one part of the same artery to another. None just go into brain tissue and come to a dead end.
I look forward to your source because it's good when you can have a conversation with a Cardiologist and prove them wrong :)
Q: You ask an interesting question (To open a totally occluded vessel etc). I'm not quite certain if that's how collaterals work? From what I've seen in my own body, the LAD which was occluded proximally, would have resulted in the complete vessel drying up totally, along with the diagonals etc. Some collaterals opened which took a feed from the distal LCX into the distal LAD.
>>>>It is known collateral vessels develops in the heart as an adaptation to ischemia. Also, it provides a channel that BRIDGE severe stenoses and opening native vessel may be beneficial as the donwstream vessel network would not have had an interrupted blood flow and under those circumstances may provide a better source of downstream blood flow?! But I am referring to collaterals that provide an alternate source of blood supply to myocarial muscle jeopardized by the occluded coronary vessel and not a bridge to the occluded vessel.
>>>>It is known collateral vessels develops in the heart as an adaptation to ischemia. Also, it provides a channel that BRIDGE severe stenoses and opening native vessel may be beneficial as the donwstream vessel network would not have had an interrupted blood flow and under those circumstances may provide a better source of downstream blood flow?! But I am referring to collaterals that provide an alternate source of blood supply to myocarial muscle jeopardized by the occluded coronary vessel and not a bridge to the occluded vessel.
You are very welcome and it is always interesting to share share both knowledge and opinions. I wish you good luck in going forward.
ed34 - I think your logic is practcal and experienced at least in my case. In addition doctor told me about development of collaterals. The plaque in my case is soft . Not hardened i.e calsified. Another explaination is I got heart attack because of loosened plaque. Where it got loosened is not clear. These are all if and buts. One thing is sure that I was adviced CABG. On second openion I have carried on medicine for one complete year even without any sort of chest pain even on exercise. Some time I feel how the heart which is full of blood can get so easily starved of blood supply ? In conclusion many things are even not yet fully known to cardiologists too. This is my practical experience I am narrating. Thank you for knowledgeable discussions with you all. Your support in discussion helped me a lot to take my decesions. My daughter in law is also doctor. Thank you once again.
My collaterals developed from med segment of the LAD. I am referring to a process that is the result of many years of gradual occlusion. The collaterals developed upstream from the occlusion and fed into areas that was gradually being depleted of oxygenated blood. I wouldn't doubt that many people go through life and don't realize the phenomonon.
To open a totally occluded vessel would increase the resistance to the collaterals cutting off the supply of good blood flow to those areas. Increasing the blood flow through the native vessel may not open the blood vessel segment that has for many years not being fed a good blood flow....my opinion! If the the down stream vessel segments do open would they duplicate the areas of blood supply fed by collaterals? What would supply the areas formally fed by collaterals?
I'm sure there are scenarios that can be thought up that may or may not be a valid consideration for potential outcome, but I and I hope the doctors make a choice based on the reality of the current situation and not what "if's". What would the world be like "if" everyone seriously acted on what "if"...isn't that being neurotic...not withstanding Murphy's Law. :)
To open a totally occluded vessel would increase the resistance to the collaterals cutting off the supply of good blood flow to those areas. Increasing the blood flow through the native vessel may not open the blood vessel segment that has for many years not being fed a good blood flow....my opinion! If the the down stream vessel segments do open would they duplicate the areas of blood supply fed by collaterals? What would supply the areas formally fed by collaterals?
I'm sure there are scenarios that can be thought up that may or may not be a valid consideration for potential outcome, but I and I hope the doctors make a choice based on the reality of the current situation and not what "if's". What would the world be like "if" everyone seriously acted on what "if"...isn't that being neurotic...not withstanding Murphy's Law. :)
"To open a totally occluded vessel would be like kicking a sleeping tiger...the outcome cannot be predicted"
Here was my way of thinking which made me decide to have my LAD re-opened.....
If collaterals close, then there is adequate pressure/flow into that area of tissue from the native vessels. If opening a native vessel doesn't supply enough pressure/flow to an area currently fed by collaterals, they should remain open...
Imagine a patient who has a blocked LAD, and collaterals are feeding from the LCX. He has no symptoms and just stays on medication. He develops blockages in his LCX to the point where ischemia starts, PLUS, the collaterals cannot now be fed due to insufficient pressure/flow,so they too close. Now not just ONE native main artery is affected, but TWO. If the LAD was open, then collaterals in this case could have opened between the LAD and LCX to help reduce damage.
Here was my way of thinking which made me decide to have my LAD re-opened.....
If collaterals close, then there is adequate pressure/flow into that area of tissue from the native vessels. If opening a native vessel doesn't supply enough pressure/flow to an area currently fed by collaterals, they should remain open...
Imagine a patient who has a blocked LAD, and collaterals are feeding from the LCX. He has no symptoms and just stays on medication. He develops blockages in his LCX to the point where ischemia starts, PLUS, the collaterals cannot now be fed due to insufficient pressure/flow,so they too close. Now not just ONE native main artery is affected, but TWO. If the LAD was open, then collaterals in this case could have opened between the LAD and LCX to help reduce damage.
Q: But doesn't medication such as GTN suggest your collaterals are far from sufficient.
...Its not the collaterals that are inefficient, it is the ICX blockage and possibly other blockages and the stented RCA may have reduced lumen. I come to this opinion because immediately after my CHF, stent implant of RCA and several days in the ICU about 7 years ago. I felt amazingly well, energetic, etc. But in the last few years there is some angina, and I take medication prior to workout. Lately, it appears that my exercise tolarance has increased where I can occasionally do 7 METs on the treadmill without any problem. 7 METs several years ago, the stress treadmil exercise was at 7 METs when the test was stopped. I know I have serious CAD from a CT scan a couple of years ago, but medication ACE inhibitor, coreg, and occasionally a nitrate...My choice and doctor's is medication rather than intervention.
Open native vessel... LAD completely blocked? My collaterals are not a problem evidenced by feeling very well for many years until I overexposed (foolishly@&*) myself to toxic environment for several days and that caused an immediate respiratory problem that turned out to be CHF. Stent ofc 98% blocked RCA and fast recovery indicates there is no problem with collaterals, but the CHF and enlarged left ventricle has caused MVR...with medication and heart size returning to normal did not correct the MVR although there was some expectation it could.
To open a totally occluded vessel would be like kicking a sleeping tiger...the outcome cannot be predicted...
...Its not the collaterals that are inefficient, it is the ICX blockage and possibly other blockages and the stented RCA may have reduced lumen. I come to this opinion because immediately after my CHF, stent implant of RCA and several days in the ICU about 7 years ago. I felt amazingly well, energetic, etc. But in the last few years there is some angina, and I take medication prior to workout. Lately, it appears that my exercise tolarance has increased where I can occasionally do 7 METs on the treadmill without any problem. 7 METs several years ago, the stress treadmil exercise was at 7 METs when the test was stopped. I know I have serious CAD from a CT scan a couple of years ago, but medication ACE inhibitor, coreg, and occasionally a nitrate...My choice and doctor's is medication rather than intervention.
Open native vessel... LAD completely blocked? My collaterals are not a problem evidenced by feeling very well for many years until I overexposed (foolishly@&*) myself to toxic environment for several days and that caused an immediate respiratory problem that turned out to be CHF. Stent ofc 98% blocked RCA and fast recovery indicates there is no problem with collaterals, but the CHF and enlarged left ventricle has caused MVR...with medication and heart size returning to normal did not correct the MVR although there was some expectation it could.
To open a totally occluded vessel would be like kicking a sleeping tiger...the outcome cannot be predicted...
I'm not so sure that the perfectionist is the problem. You can sit there all day trying to perfect something, but if you don't let frustration get the better of you, then it's fine. I do agree however with your analysis of stress with no solution being a HUGE issue. BOTH my heart attacks were just a couple of months after my Wife went through very traumatic illness and surgery, something I had no control over. Like you it wasn't immediate, in fact, it was when the stress came to an end that I felt the chest pains.
Thank you all for valuable information and experience provided. As additional information in my case I have to state that I am 71 years old person and I am type B personality in medical terms. I am perfectionist and stress arising from that may kill me one day. Some time I feel that I can tolerate the stress but I can not tolerate the release of stress. In both my cases of heart attack I had extreme stress prior to attack but not immediate prior. My own feeling is the stress is my enemy. Psychological stress arising out of no-solution to the problem and personality being perfectionist. Any suggestions are wel come.
" If I had symptoms, I may have gone for stent implants and that would have prevented collateral vessels developing that has provided a natural bypass"
"I have an ICX that is 72% blocked, but I take a nitrate prior to going to the Health Center for exercising"
But doesn't medication such as GTN suggest your collaterals are far from sufficient?
Why do you feel it would be far less beneficial to have the native artery fully opened?
"I have an ICX that is 72% blocked, but I take a nitrate prior to going to the Health Center for exercising"
But doesn't medication such as GTN suggest your collaterals are far from sufficient?
Why do you feel it would be far less beneficial to have the native artery fully opened?
It would be difficult to conclude a prior heart spasm caused your heart attack especially when there is evidence of occlusions that may have caused an ischemic heart attack. Unless there is some objective evidence of spasms (seen during test, etc.) the analysis may only include the objective evidence of your occlusions. Demographics may be considered such as most common with younger adults, but older individuals can have episodes especially in older women.
If I remember correctly about 25% of the CAD population don't experience angina pectoris. I didn't have any symptoms of a heart issue until the symptoms of heart failure (chf). Not having angina pectoris with occluding vessels can be a problem, but I consider my asymptomatic CAD beneficial. If I had symptoms, I may have gone for stent implants and that would have prevented collateral vessels developing that has provided a natural bypass.
I have an ICX that is 72% blocked, but I take a nitrate prior to going to the Health Center for exercising. If I suspected my heart cells were not getting enough oxygen and a possiblilty of being in the category of asymtomatic, I would have a stress test to determine the adequacy of blood perfusion and whether there should be angina that is not being expeienced. A stress test can determine your exercise tolerance and degree of exercise the most beneficial without deleterous effects. I can determine my limit by angina and muscle fatigue.
Ken
If I remember correctly about 25% of the CAD population don't experience angina pectoris. I didn't have any symptoms of a heart issue until the symptoms of heart failure (chf). Not having angina pectoris with occluding vessels can be a problem, but I consider my asymptomatic CAD beneficial. If I had symptoms, I may have gone for stent implants and that would have prevented collateral vessels developing that has provided a natural bypass.
I have an ICX that is 72% blocked, but I take a nitrate prior to going to the Health Center for exercising. If I suspected my heart cells were not getting enough oxygen and a possiblilty of being in the category of asymtomatic, I would have a stress test to determine the adequacy of blood perfusion and whether there should be angina that is not being expeienced. A stress test can determine your exercise tolerance and degree of exercise the most beneficial without deleterous effects. I can determine my limit by angina and muscle fatigue.
Ken
chest problem is normally shown in old men women. They have chest pain. In chest pain patient they have big pain in chest.
It's an interesting question. To diagnose coronary artery spasm is not easy, you would have to witness it during an angio procedure or a good cardiologist can usually go by the symptoms. In the three months I had spasms, I could feel a very odd fluttering in my chest, and each flutter sent a wave of cold through me. It was like a shiver. My spasm was observed in my angio procedure and the artery was in a fast spasm, closing to around 10% of normal flow. Each episode lasted around 20 seconds, and I had 2-3 episodes a day. There was no particular trigger mechanism, but in many cases there are. Some people for example have them after eating, some during exertion which gets confused with stable angina.
When someone has an artery spasm in the brain, they put lots of fluids into the patient to boost blood volume, to help keep the artery forced open. The artery seems to eventually settle down in most cases. I wonder why they don't employ the same techniques with coronary arteries.
When someone has an artery spasm in the brain, they put lots of fluids into the patient to boost blood volume, to help keep the artery forced open. The artery seems to eventually settle down in most cases. I wonder why they don't employ the same techniques with coronary arteries.
Have an Answer?
You are reading content posted in the Heart Disease Community
Is a low-fat diet really that heart healthy after all? James D. Nicolantonio, PharmD, urges us to reconsider decades-long dietary guidelines.
Can depression and anxiety cause heart disease? Get the facts in this Missouri Medicine report.
Fish oil, folic acid, vitamin C. Find out if these supplements are heart-healthy or overhyped.
Learn what happens before, during and after a heart attack occurs.
What are the pros and cons of taking fish oil for heart health? Find out in this article from Missouri Medicine.
How to lower your heart attack risk.
You ask an interesting question (To open a totally occluded vessel etc). I'm not quite certain if that's how collaterals work? From what I've seen in my own body, the LAD which was occluded proximally, would have resulted in the complete vessel drying up totally, along with the diagonals etc. Some collaterals opened which took a feed from the distal LCX into the distal LAD. This meant blood flowed through the LAD in the opposite direction, but a small feed was available in the native vessels at all times. I was under the impression that this is how collaterals worked? I don't know if they grow into muscle and directly feed it because this requires formation of capillaries for gas exchange. So, I would have to say that if a vessel is totally occluded, yet fed by collaterals to some extent, then opening the blockage would result in the native vessel continuing to supply the muscle, as it has always done, but with better flow, and the collaterals will close until required again.
Does this sound plausable?