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An_250170 posted:
I had the widow maker 4 years ago, 2 months ago I was in the hospital and they found 2 40 percent blockages in my LD I already have a stent. They are doing noting should I get a second oppionin? I have been having chest pains and other symtems.
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cardiostarusa1 responded:
Hi:

"Should I get a second opinion?

Sure, even if it turns out being only to get some peace of mind in the matter.

......"and they found 2 40 percent blockages in my LD"

"They are doing nothing"


Doctors typically consider/perform angioplasty, with or without coronary stents on blockages of 70%75% or greater in the right coronary artery (RCA), left anterior descending (LAD), left circumflex (LCX) and some of their respective branches, also taking in consideration present symptoms and the severity thereof."

"I have been having chest pains and other symptoms".

As reported, the symptoms of artery-narrowing atherosclerosis are highly variable. Those with mild atherosclerosis may present with clinically important symptoms and signs of disease and heart attack, or absolute worst case scenario, sudden cardiac death (SCD) may be the first and only symptom of coronary artery disease (CAD). However, many individuals with anatomically advanced disease may have no symptoms and experience no functional impairment.

In some cases, chest pain may/can be caused by coronary artery spasm (CAS), which is a transient constriction or a transient total closure of a coronary artery, typically, but not 100% always, occurring at rest. CAS may/can occur at the site of a mild blockage or even where there is no visible blockage. There is also microvascular disease, aka Cardiac Syndrome X (CSX), a problem going on in the heart's bed of capillaries,

Additionally, there is a non-cardiac condition known as esophageal spasm (ES), which can mimic angina-like chest pain and sometimes discomfort. In some cases, even radiating to the arm, neck, jaw, and back. The definitve test for ES is esophageal manometry.

The bottom line

Coronary stents (drug-eluting or bare-metal) are only a Band-aid or spot treatment, as it does not treat the underlying disease process and what drives the progression.

Coronary artery disease (CAD) is a life-long unpredictable condition (can exhibit periods of stabilization, acceleration, and even some regression), requiring a continuum of care,

Best of luck down the road of life.

Take care,

CardioStar*

WebMD member (since 8/99)

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Be well-informed

WebMD

Living with Coronary Artery Disease (CAD)

A chronic disease with no cure. When you have coronary artery disease, it is important to take care of your....

This is especially true if you have had an interventional procedure or......

Recognize the symptoms. Reduce your risk factors. Take your medications. See your doctor for regular check-ups...

http://www.webmd.com/heart-disease/guide/living-with-heart-disease

Coronary artery anatomy

http://www.heartsite.com/html/lad.html

_ . _

Good to know, for the primary and secondary prevention of heart attack and brain attack/stroke

Epidemiologic studies (EDS) have revealed risk factors (encompasses some new, novel or emerging) for atherosclerosis, typically affecting the carotid, coronary and peripheral arteries, which includes age, gender, genetics (gene deletion, malfunction or mutation) , diabetes (considered as being the highest risk factor), smoking (includes second and thirdhand), inactivity, obesity (a global epidemic, "globesity"), high blood pressure (hypertension), Low HDL (now questionable, according to recent studies) high LDL, small, dense LDL, RLP (remnant lipoprotein), high Lp(a), high ApoB, high Lp-PLA2, high triglycerides, HDL2b, high homocysteine (now questionable), and high C-reactive protein (CRP/hs-CRP).

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Quote!

"Be a questioning patient. TALK to your DOCTOR and ASK QUESTIONS. Studies show that patients who ask the most questions, and are most assertive, get the best results. Be vigilant and speak up!"

- Charles Inlander, People's Medical Society

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It's your future......be there.

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WebMD/WebMD forums does not provide medical
advice, diagnosis or treatment.

NEVER delay or disregard seeking professional medical advice from your physician or other qualified health provider because of something you have read on WebMD.

IF YOU have a medical emergency CALL 911.
 
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billh99 responded:
There is a newer test FFR - fractional flow reserve - that shows how much the flow is reduced. Trails indicate that test is better than using a fixed percentage of blockage.

But at 40% most likely not the problem.
 
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dyingforwalmar replied to cardiostarusa1's response:
Thank you for the advice. I wont survive sudden death again.
I worry that if on of the other blockages lets loose and moves it wire block he LAD again. I will get another opinion for some piece of mind.
 
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James Beckerman, MD, FACC responded:
We typically recommendation medical therapy, and not stents, for coronary blockages that are in that range of severity.
 
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cardiostarusa1 replied to dyingforwalmar's response:
You're welcome.

"I worry that if one of the other blockages lets loose and moves it will block the LAD again."

While blockages typically/usually do not "let loose", as they stay fixed, obviously the blockages may/can go/progress to 100% at any time.

Extremely noteworthy, and as applicable to the patient, there are coronary artery collaterals (a natural development, a gradual process, one's own "bio-bypass" so to speak), which involves tiny (rescue or backup) vessels, that connect two larger coronary arteries or different segments of the same artery. These vessels provide an alternate route for blood flow to the heart muscle (myocardium) when called for in an emergency.

Those who have well-developed (and open) coronary artery collaterals are the lucky ones (as my father was), because this form of blood supply helps protect the heart from an attack, or limits the damage to the heart muscle from tissue death if/when the normal blood supply is totally cut off.

The main drawback is that these collaterals are not really meant to carry the whole load of the heart, though they may/can provide significant blood flow in some individuals.

These vessels seldom delivers the same amount of blood flow that the unblocked native artery or arteries originally did, but the blood flow may be/can be enough to ease/reduce chest pain/discomfort in some individuals and reduce the risk of a serious heart attack or even death some time later on.

Additionally, looking at the most known causes of a heart attack (myocardial infarction, MI), which can be instantly fatal in some cases, the most common is now recognized worldwide as vulnerable plaque (VP), a soft and potentially deadly type of plaque.

VP is essentially hidden (can't be seen with invasive X-ray angiography, heart catheterization) arterial landmines/time bombs, 0% blockages (though unequivocal atherosclerosis) with the potential to kill, when rupturing and triggering off a blood clot (thrombus).

Following VP is the tight (stenotic) atherosclerotic plaque blockage (which typically but not always causes symptoms such as angina pectoris, and shortness of breath), eventually going to 100% occlusion with or without a blood clot.

Take good care,

CardioStar*

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It is always ultimately up to the patient to be his/her own best health advocate.
 
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kimmgarr replied to James Beckerman, MD, FACC's response:
hi, this is my first time here so not sure if I am responding where i need to be. I am 42 yrs. old had 2 heart attacks within 24 hours.(april 11, 2012) they cathed me and put 3 stents in my lad. I have been having so many problems my cardiologist doesn't seem to want to listen. I don't know what to do. can't do anything without getting out of breath or my chest hurting. my depression has also gotten worse. I take exactly 17 meds a day. I dont know where to turn for help about my heart. i would appreciate any advice. I went for a second opinion and that dr. told me that I had a heart attack no big deal get on with your life. it is rather impossible when i cant do anything and i hurt all the time. PLEASE HELP ME. THANK YOU SO VERY MUCH.
 
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cardiostarusa1 replied to kimmgarr's response:
Hi:

"I take exactly 17 meds a day."

WOW!

I know you said that your cardiologist doesn't seem to want to listen, though it would be a good idea to make the effort in reviewing each one to see if you really truly need all that and check for possible side effects too.

You have to be your own best health advocate.

"Had 2 heart attacks within 24 hours.(april 11, 2012)"

"Can't do anything without getting out of breath or my chest hurting."

After a heart attack has occurred, it is important to know/keep track of the left ventricular ejection fraction (LVEF), the single-most important clinical indicator of heart function, how well the heart is pumping.

Normal resting range is 50%-75%. Under 50% enters into the realm of dysfuncyionl territory that goes from mild to moderate to severe heart failure.

Cleveland Clinic

Understanding Your Ejection Fraction

http://my.clevelandclinic.org/heart/disorders/heartfailure/ejectionfraction.aspx
Did you have cardiac rehab? Typically, cardiac rehab plays an important role in the overall recovery process, which is DIFFERENT FOR EVERYONE and at any age.

WebMD/Healthwise

Cardiac Rehab

http://www.webmd.com/heart-disease/tc/cardiac-rehabilitation-topic-overview

Mayo Clinic

Cardiac rehab: Building a better life after heart disease

http://www.mayoclinic.com/health/cardiac-rehabilitation/HB00017

Mended Hearts

Hope for recovery. Hope for a rich, full life.

For more than 50 years, Mended Hearts has been offering the gift of hope and encouragement to heart patients, their families and caregivers.

http://www.mendedhearts.org

"My depression has also gotten worse"

That is unfortunate.

It is well known that depression, be it periods of, or chronic, happens in many individuals who are diagnosed with cardiac-related conditons, especially if a heart attack has occured, with or without stents or bypass. Sometimes, depression can even be a side effect from a prescrption drug.

Cleveland Clinic

Depression & Heart Disease

http://my.clevelandclinic.org/heart/prevention/stress/depressionandheart.aspx

Best of luck down the road of life.

Take care,

CardioStar*

WebMD member (since 8/99)



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AVOID foods high in saturated fat and cholesterol. CHOOSE skim or low-fat milk, low-fat yogurt and reduced-fat cheeses. Eat more fish and poultry. LIMIT servings to five to seven ounces a day. TRIM visible fat. Limit egg yolks. SUBSTITUTE two egg whites for one whole egg or use an egg-substitute. Eat more fruits and vegetables, whole grains, breads and cereals. USE LESS salt and fat. SEASON WITH herbs and spices rather than with sauces, gravies and butter

_ . _

Good to know, for the primaryand secondary prevention of heart attack and brain attack

Epidemiologic studies (EDS) have revealed risk factors (encompasses some new, novel or emerging) for atherosclerosis, typically affecting the carotid, coronary, and peripheral arteries, which includes age, gender, genetics (gene deletion, malfunction or mutation) , diabetes (considered as being the highest risk factor), smoking (includes second/thirdhand), inactivity, obesity (a global epidemic, "globesity"), high blood pressure (hypertension), Low HDL (now questionable, according to recent studies) high LDL, small, dense LDL, RLP (remnant lipoprotein), high Lp(a), high ApoB, high Lp-PLA2, high triglycerides, HDL2b, high homocysteine (now questionable), and high C-reactive protein (CRP/hs-CRP).

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