Doctors with conflicting treatment options

Question

Hi. I am a 51 year old female who had a heart attack at age 48-100% blocked LAD, which was able to be stented. From what I am told, I am lucky to be alive. But, the doctors cannot figure out why I have heart disease. I have several other blockages, mostly between 10 to 15%, but one is at 65% and cannot be stented because of location. I also have heart failure. My heart rate is usually in the low 50's. Yesterday, I felt very sluggish and my blood pressure was 80/53 and pulse was 46. My blood pressure has always been low, and cholesterol normal. I have never smoked, and am not overweight (5'8", 133 lbs) and am physically active-aerobics classes as well as chasing around 20 three year olds all day. The only family history is my 80 year old grandma possibly died from heart attack, and my 70 year old dad had bypass a year before my heart attack, so the doctors discounted them. My first cardiologist wants me to have a bypass on the 65% blockage and a pacemaker put in. He sent me to an interventional cardiologist and this one says not to rush into a pacemaker or bypass surgery (which I really do prefer to put off if possible) but I am scared and do not know which doctor is right. How can you know which is the right course of treatment? I do not want unnecessary surgery, but I also do not want to have another heart attack. Melanie

This discussion is related to Do I really need a pacemaker?.

TMJMel · Answer

Thanks for insinuating that I am young!  I feel pretty old right now.  I know in cardiac rehab, I was the youngest by about 20 years and they could not believe I was there with them.  I was "the kid"  I agree that the surgeon should know the necessity better.  I just don't want to have another heart attack.  The first one was soooooo bad.   But in rehab, everyone kept scaring me when they talked about "my first heart attack"  It seemed that they all had had at least a couple and that is pretty scary at 48 when you just had a heart attack out of the blue with no warning or risk factors.  I just hope this doctor knows what he's talking about.  But he should-he's the doctor!     Melanie

TMJMel · Answer

The interventional cardiologist told me that it would be "like killing a sparrow with an atomic bomb" to have the surgery now.  It would be effective, but overkill.  He said they would like to wait until it is 70-75% blocked to do the surgery.  He told me that could take 5 years or more and technology could come a long way by then so it would be worth the wait.  He also said that if I am not passing out from the low heart rate, he does not want to go sticking wires into my heart.  That makes sense to me.  I feel sluggish a lot, but he used the "King of Hearts" monitor on me for a month and he said there were several slower heart rates, but they were steady, not erratic so that was good anyway.  But my first cardiologist does not feel comfortable treating me with the blockages and the low heart rate, so I had to switch to the interventional one.  The only problem is our local hospital cannot do a lot of the necessary procedures and I have to go to a town an hour away (where they sent me by ambulance after my heart attack) to get treated, and this doctor cannot practice there, so I have to have someone there who is familiar with my case also.  I am so scared to eat anything with any fat in because I feel it is going straight to the blockage.  They tried angioplasty, but it came right back.  The new dr. said that if I have a heart attack on this blockage, it would not be as devastating as the first one.  Well, I am not so sure of that.  Maybe not physically, but emotionally, I'm pretty sure it would not be good.             Melanie

Jerry_NJ · Answer

The good thing is your young age should give you better/great recovery capacity.

When I went to a surgeon to discuss heart surgery for a mitral valve repair/replace I was under the impression from my cardiologist that it was a "call" for the surgeon to make.  The surgeon agreed.  My experience with heart surgery was very good.  My surgeon specialized in bypass and valve surgery.  If you have surgery a key is to get a doctor who does those same surgeries almost every day, at least a few per week...practice makes perfect.

So, from my experience, I'd say the surgeon is the strong vote on when to undergo surgery.  That's just my thought.

As you can see, I was lucky, I didn't have any heart problems until I was much older than you.. and even with that I recovered from surgery without an problems.

Mom2four85 · Answer

Hi Melanie; I'm not sure on the answer to that but wanted to suggest something.

Check your insurance to see if youre covered to go to one of the large clinics like Cleveland, Mayo etc.  

That's amazing you had a heart attack at 48 and they don't know why especially being 100% blocked.

Being 65% blocked would worry me too and I personally would want that to be corrected as a precaution.  If you're having Bradycardia (I do also) a PM would help pace your heart and help you.  

Did the interventional cardio give reasons or explain why to wait?

I wasn't given much choice with my pm/icd - I have malignant pvc's that acted up during ablation surgery and had to have it implanted.

Good luck and hopefully someone will be able to help you a bit more than I did.