100% LAD Occlusiion but no heart damage

[RajanN]

I had a heart attack on 19-Nov-2009 and had to be rushed to ER. I am 55 years old and have a very strong family history of heart disease. I had mild chest pain and only went to my regular PCP thinking it is indigestion but he took and EKG and called the ambulance immediately. I was taken into the cath lab where the interventional cardiologist had to put in five stents in my LAD. He later told me and my family that there was a 100% occlusion of the LAD exactly at the spot where the Left Main branches off between LAD and Circumflex. He said that on the cath X-Ray he could see absolutely no blood flow down the LAD. He also said that the clot was hard which made him suspect that it had formed at least since the last 24 hours. He added that I should have come in much earlier and a few more hours could have been fatal. He finally said that he expected a good amount of heart damage.
Now here is my question - follow up echo cardiogram showed NO DAMAGE to heart at all and ejection fraction was measured at a normal 55%. The cardiologist did not trust the echo and ordered it again. Once again it showed the same results. And I feel perfectly fine. I can even play tennis. I don't blame the cardiologist - he did what he had to do on the cath table but I am wondering how when he could actually see no blood flow in LAD there was no damage. My PCP who is a very knowledgeable doctor explained this by attributing it to collateral circulation. I would very much appreciate if anyone on this forum can throw some light on this and if I can do any further tests to find out more.

[kenkeith]

Six years ago, I had a silent heart attack.  My LAD was/is 100% occluded midway, a stent was implanted on 98% blocked RCA, and the circumflex is 72% occluded, no stent. Tests showed some heart wall cell damage and that caused my ejection fraction to be below 29%.  Apparently, the heart cells were just stunned or hibernating cells.  These cells can be revitalized with timely treatment that provides a good supply of oxygenated blood and EF can return to normal (55 to 75% blood pumped out of circulation with each heartbeat).

Obviously,a 100% occluded LAD would be fatal, but other vessels developed (angiogeneisis, arteriogenesis) that feeds into the area that originally was fed by LAD.  I, also, was able to do normal exertion and work without any symptoms.  I felt very good, after several days in ICU to normalize oxygen ratio after congested heart failure.  No problems since that event.

An echo with good reliability can determine whether there is heart wall impairment (damaged heart cells) medically referred to as hypokinesis or akinesis (dead cells).  The impaired wall reduces contractility and that lowers the EF.  The echo can measure volume when the heart chamber is filled (maximum volume) and measure again after contraction (least volume) and get an estimate of the ejection fraction (EF).

Your PCP can advise if there is any further testing required.