franners-cardiac

[franners]

I am 56 year old female,healthy weight,active working nurse in the ER. Three years ago after a routine stress test after my 55 year old brother died suddenly ,failed the stress and my cath showed 80% occlusion of  LAD,stent was done.Four months ago my stent occluded,I had been feeling poorly for about 8 months before but my doc and I both thought I was just over dramatic becasue I have always stayed busy,working but lost 13 # secondary to bloating and just general malaise.My stent was 90% occluded proximal and 80% distal-restented. I have continued to feel poorly,especially SOB-my hemodynamics on my cath showed LVDP was 20. Now I am on Lasix,coreg,prinivil,k-dur, my doc feels now I am in early CHF. My question is when does bypass surgery become an option? I have only minimal irregularities in the RCA and Circumflex,septal branch is occluded. I guess I am worried if this stent occludes the heart failue will become worse and I could become a cardiac cripple. I am also on plavix and a full asa. I was on plavix for 8 months after my first stent and continued on a full asa. I a m a very compliant pt and do not want to obscess about  my heart disease, but most of last year I thought I was a hypochondriac,my doctor at want point suggested that I might have fibromyalgia secondary to my arm pain. I am not sure what to do next. If bypass surgery could get me back to myself I would do it in a second.My last EF three weeks ago on an echo was 50%. Thank you for reading this.

[franners]

I am on a statin drug,my LDL is 80,I have been unable to tolerate high doses secondary to muscle aches. My SOB is very frustrating to me, it comes and goes at times unrelated to activity. At night especially when I lay down I always feel a little panicky secondaary to sob-eventually it settles somewhat, I sleep on 2 pillows. Usually after about 3 hours I get  up and sleep in a chair and can fall asleep.It is hard for me to believe that my heart is this bad. My initial stent was occluded promixmal lad at the leading edge of  the stent and was also mid and distal occlusion.
I know my ejection fraction isn't that bad-so I guess I worry that I imagine the sob. I am just very frustrated.
Thank-you for listening.

[Flycaster305]

I'm really anxious to read the doctor's reply, I think this is a set of questions that so many of us with blockages have at one stage of our disease or another.  The SOB symptoms that I have had from time to time almost always meant another occlusion, either restinosis or thrombosis; I have a hunch another heart cath is in your future.  From your symptoms, I'd push hard for one.

I would mention this:  Coreg is for me a wonder drug, it raised my ejection fraction from the 30% level to about 45%, but it wasn't an easy journey, Coreg can knock the wind out of your sails, and that might be the breathlessness and fatigue you feel.  I do know Coreg is a difficult drug to 'dose', people react to it very differently and need widely different dosages to be effective.  Good luck to you.

[Cleveland Clinic]

You present a difficult case. If I am reading this correctly you had a stent in your LAD ( ? proximal, mid or distal) which then developed instent restenosis which I presume was treated with restenting. You did not have a significant heart attack, if I am reading this correctly and your ejection fraction is low normal. You are on an ace, BB, lasix  and potassium, aspirin and plavix. Why are you not on a statin? this is the only medication shown to decrease the risk of atherosclerosis progression and death in patients at high risk, like yourself. Goal LDL of 60 should be what your physician was aiming for.
If, despite maximal medical therapy you continue to have in stent restenosis, then I would suggest that you see an expert in interventional cardiology. The spectrum of interventional cardiologists varies greatly, and some are much much more experienced than others and tend to have far greater success with successful stenting.
If despite these measures, your LAD stents continue to stenose, and this stenosis is in the proximal part of the vessel and there are adequate target vessels to bypass to, and you continue to have symptoms then you may be a very good candidate for a single vessel LIMA to LAD bypass.
I would proceed in the order that I have suggested hese to you.