question about heart cath

[lucky90]

I had a heart attack 2/15/08 - Had a heart cath done the next day. The doctor
said the blockage was 95% but the area was too small to place a stent. I had
a stress test about a month after that. The stress test came back abnormal.
The doctor then said he was going to go ahead and put a stent in. Yesterday,
6/3/08 I had the heart cath done again.The doctor still did NOTHING. He said
the damage was already done and it would be too risky to try to put a stent in.
That's all he told me and I'm really confused. I go back in 2 weeks for a follow up.
Any suggestions on what I should ask him ?

Thanks in advance for any advice.

[kenkeith]

You can google the COURAGE study.  The medical trial involved testing whether there was any difference in longiviity to those who were stented, by-pass and medication.  The result showed no difference.  It can be concluded if pain is controled by medication (some can't tolerate meds), then a stent if not contraindicated due to size, degree of blockage and location (sometimes the blockage is close to  branch and stented would close the branch for instance).  And sometimes surgery is required when time is of the essence (matter of life or death).

Medications serve my condition well!

[lucky90]

On 2/15 I had extreme chest pain ,nausea, arm & shoulder pain,etc. My blood pressure had been extremely high for a couple of months. I was also diagnosed with Hep C and mild kidney disease. My wife took me to the E.R. The blood tests did confirm a heart attack although the EKG was normal. I was transferred to another hospital in our area to have the heart cath done the next day. They did take pictures of my heart and checked the valves, etc. The only thing that was abnormal was my stress test. The first heart cath DID show the blockage but the doctor choose not to stent, just to put me on Plavix for awhile.I really don't think he expected my stress test to come back abnormal. That's when he said he would go ahead and put a stent where the 95% blockage was. I have a couple of smaller areas that are also blocked but he said those were also too small to mess with. As of now I have no pain at all. The reason I consented to the second cath is because that's what I thought was needed, then he opted not to do anything again. I hate to think it's money motivated.   I need to know what I can do (physically) and can't do. Your'e right, I need a second opinion. I'm frustrated for spending time in the hospital and away from work feeling like
I've gotten nowhere. Thanks for your response and opinion ! I go back to my doctor on
6/17 so I will have PLENTY of questions for him.

[kenkeith]

What was/is the clinical evidence of your heart attack?  What were your symptoms?  Have you had an echocardiogram, and if so does the beating heart show any heart -wall movement impairment?  Location of any impairment?  On 2/15 was there a blood test that showed markers indicating heart muscle damage.  Do you have copies of the test reports and doctor's impression?

For a perspective, I had pulmonary edema, and at ER it was diagnosed as CHF and having had a heart attack.  The usual protocol is to take an x-ray of the heart (mine showed some enlargement).  Blood test. And when ischemia (lack of blood flow) to the heart, there is a cath done with your permission (I was shown x-ray, had pulmonary edema).  I gave my permission and there was stent placed in a 98% blocked RCA, the ICX was 72% blocked and not stented, and the LAD was/is 100% blocked and no stent.  But the totally blocked LAD had developed a natural by pass with collateral vessels (to put in a stent would not be helpful...is that your situation?).

I don't understand your doctor stating it was too risky to implant a stent? Sometimes there is blockage where the artery bifurcates or it vessel is tortuous, and that may be what is happening?!

A year later  I was given a stress test!  My experience and some understanding from having heart issues and tests does not correlate well with your experience and procedures.  The only explanation I can come to is that the first cath missed the blockage revealed by the stress test and so there was another cath to open the blockage observed by the stress test, but that was not done?!  You are due an explanation why the second  cath and why there was no remedy to an alleged blockage??!!

You should get another opinion, and I don't believe I would have permitted the second cath without a good explanation.  Are you experiencing chest pain (angina) uncontrolled by medication?  If medication can control your symptoms, there is no need to proceed with an intervetional procedure (cath or by-pass).

[Flycaster305]

I also had a blockage in a very small heart artery, too small for a stent.  Usually other small surrounding arteries will expand and take over supplying the area of the heart with blood.  This process is helped, as I understand it, with drugs like Coreg and of course regular exercise.