Angioplasty vs Bypass
This is my first posting to this group. I had a mild heart attack 2 months ago and spent 9 days in the hospital. I was diagnosed with triple artery CAD and atrial fibrillation. Medication has not helped and I have severe angina. I recently had a thallium stress test which showed parts of my heart are not getting enough blood and the ejection fraction is low. Anyway, my doctor has been vacillating about how to treat this. It seems he wants to avoid bypass surgery because I'm still fairly young (54) and women often have more problems after bypass. Right now, I am scheduled to go to the hospital a week from Thursday and he plans to try and do several angioplasties with stents on the three veins but he is still holding open the option of a bypass. My question -- does anyone have any experience with having angioplasty done and then ending up with a bypass done later anyway. Although I don't look forward to a bypass, I wonder if it would be better to just get it over with since it seems to me I might end up with a bypass at a later time anyway. I have several severe blockages (60% or more) and some of them extend a long way in the vein. I would appreciate any thoughts about this, words of encouragement, etc. Judy in Arlington, Virginia
You asked: My question -- does anyone have any experience with having angioplasty done and then ending up with a bypass done later anyway. I answer: Yes. more on that later - If you go the angioplasty route, INSIST on the new medicated stents which seem to eliminate re-occlusion post angioplasty. If I were in your shoes , I would go that route. My first angio (8 yrs ago, age 41) re-occluded in 2 months. The repeat angio caused my only m.i. , in the hospital. 18 Months later, cardiac arrest on treadmill, then bypass and ICD(defib) implant. Have done o.k. with bypass last 8 years. The medicated stents seem to prevent re-occlusion(worth repeating). You say that your disease is distal (extend a long way in the artery); I would also recommend meditation, lifestyle adjustment, diet, exercise, statin drugs(e.g. zocor, mevacor, lipitor) , b-vitamins (niacin, folic acid, and b-complex). Good luck. Harold
I had angioplasty in 1991 (age 49)and bypass surgery in 2002. I did quit smoking, started exercising and was eating much less fat in addition to taking lipitor and an aspirin everyday. I was royally upset when they told me I had six blockages in 5 arteries. I only had one blockage in 1991. It almost made me go back to smoking. I also had no symptoms so I am still angry that this happen to me as I believed I was doing the right thing to prevent it. I had no symptoms and would not have known if I hadn't had an ekg that showed ischemia and that led to a stress test that showed restricted blood flow to the lower part of my heart. Today, I feel bad everyday. My chest hurts, my back hurts between the shoulder blades, my neck hurts and my leg left leg is numb. I wish I had not agreed to this surgery even though I do believe I had the blockage I might have enjoyed life more if I had just gone on with the blockage. I do exercise daily and do aerobic exercise 3 times a week. I eat 20 to 30 grams of fat and did not go back to smoking. I just don't know if any of that does anything more than make me sore and hungry.
I don't know for sure but I do understand that niacin is not good for you if you have had angio or bypass surgery so you need to check with your cardiologist before taking that medicine. Even vitamin E is no longer touted as good for the heart. They are learning new things everyday and its really hard to know what to do.
What is this about niacin and bypass? Any facts or references? Thanks Harold In a message dated 8/20/2003 1:26:52 PM Eastern Daylight Time, ramblingrays@... writes: you have had angio or bypass surgery so you need to check with your cardiologist before taking that medicine. Even vitamin E is no longer touted as good for the heart. They are learning new things everyday and its really
Ray, have you been tested for high homocysteine and high c-reactive protein in your blood? The AHA and others in the field now consider these to be high risk factors right along with family medical history, smoking, high cholesterol, high BP and obesity. If you haven't been tested I would ask your cardiologist about it. Good Luck Chris In a message dated 8/20/03 10:45:18 AM, ramblingrays@... writes: << I eat 20 to 30 grams of fat and did not go back to smoking. I just don't know if any of that does anything more than make me sore and hungry.
The only thing I have heard about using niacin is that if you're also taking a statin to get your lipids down you may overdo it and also may increase your liver enzymes. I was considering it at one time but I couldn't get over the flushing of my skin, even at low dosages of niacin. Regards, Chris In a message dated 8/20/03 8:33:08 PM, HaroldCNJ@... writes: << What is this about niacin and bypass? Any facts or references? Thanks
Hi Harold, I looked up niacin and it's side affects. Large doses can cause Liver damage, peptic ulcers, and skin rashes. The article said it should only used with medical supervision due to the potential for severe side effects. If you want i can send you the article. nancy PS have to get to work but will reserch it more when I get home and see if I can find what affect it has on people that have had a bypass
Thanks Sunshine; I am aware of the liver-damage concern, especially when used in combination with statin drugs. What I am NOT aware of is the concern expressed about "niacin and bypass". Did the person really mean 'bypass' in this context? I use the normal liver function test that one does when on statins to montior that. I did decrease my dose of niacin and also take it separated by time from my statin dose, based on my primary doctor's concern. Instead of 500 mg twice a day , I now take it once a day. Harold
Hello Judy, I had a heart attack in my 40's. The cardiologist was afraid to do an angioplasty at the time because of the location of blockages. Several years later when my symptoms were worsening and the angioplasty technology had improved, they performed an angioplasty on two sites which gave me my life back. Six months later, I was feeling symptoms again due to *restenosis* (closing of the angioplasty sites) and they performed a second angioplasty which lasted 7 years. At that point, a new site had developed in a *critical* artery and I had a triple bypass in my mid 50's. Nowadays, they insert the stents to prevent restenosis. To my mind, 7 good years for a couple of hours in the catheterization lab was a GOOD tradeoff. I can understand the dilema your Cardiologist is feeling. Diffused blockages are difficult to treat with angioplasty. Also, the risks depend on which arteries are blocked. Doing angioplasty on the Left Main Artery carries a higher risk than the smaller arteries that fan out to different areas of the heart. At 60%, many (most?) Cardiologists would wait for symptoms to worsen before doing invasive procedures. The numbers I remember are 70 to 90% for angioplasty. At 90% blockage and above, bypass is generally recommended, especially if there are multiple arteries affected. Physical symptoms such as you describe are also factored into consideration. Another consideration is the durability of the ByPass Grafts. Grafts from the Mamary Arteries typically last forever. Grafts from leg (or arm) veins often need to be replaced or at least opened up (stents help a LOT here) after 8 to 12 years which is why many doctors like to postpone Bypass surgery as long as possible. The technology is continuously advancing. You may want to get an appointment with a surgeon to get his opinion. Also, see if your cardiologist will discuss the tradeoffs in more detail with you. Ask them about the risks of both approaches and which arteries are most critical. Good luck with your decision. 'AL' In a message dated 8/20/03 2:21:10 AM Central Daylight Time, judimarie@... writes: << This is my first posting to this group. I had a mild heart attack 2 months ago and spent 9 days in the hospital. I was diagnosed with triple artery CAD and atrial fibrillation. Medication has not helped and I have severe angina. I recently had a thallium stress test which showed parts of my heart are not getting enough blood and the ejection fraction is low. Anyway, my doctor has been vacillating about how to treat this. It seems he wants to avoid bypass surgery because I'm still fairly young (54) and women often have more problems after bypass. Right now, I am scheduled to go to the hospital a week from Thursday and he plans to try and do several angioplasties with stents on the three veins but he is still holding open the option of a bypass. My question -- does anyone have any experience with having angioplasty done and then ending up with a bypass done later anyway. Although I don't look forward to a bypass, I wonder if it would be better to just get it over with since it seems to me I might end up with a bypass at a later time anyway. I have several severe blockages (60% or more) and some of them extend a long way in the vein. I would appreciate any thoughts about this, words of encouragement, etc. Judy in Arlington, Virginia
I do have very high c-reactive protein. The cardiologist really didn't have anything to say about it when I ask him what it meant. He was extremely busy that day with several emergencies and I will ask him again when I see him next month. I have no idea about the homosystine. Will ask about that also. I had looked up the C-reactive protein and decided it was because I have arthritis in my hands and knees. What information do you have about it?? Ramblin
In a message dated 8/21/03 6:03:14 PM, ramblingrays@... writes: << I do have very high c-reactive protein. The cardiologist really didn't have anything to say about it when I ask him what it meant. He was extremely busy that day with several emergencies and I will ask him again when I see him next month. I have no idea about the homosystine. Will ask about that also. I had looked up the C-reactive protein and decided it was because I have arthritis in my hands and knees. What information do you have about it?? I don't have much about the C reactive protein but I think it is a bit of data that tells how much inflamation you have in your body. The homocysteine level, assuming it is high can be lowered quite easily by taking folic acid. Good luck. Chris
Thanks to all of you who responded to my message about the pros and cons of bypass vs. angioplasty. Your thoughts were very helpful. This whole experience has been very traumatic for me since I thought my heart was fine. Guess annual physicals with normal EKG's, cholesterol and blood pressure can give you a false sense of security. Appreciate being added to a prayer list, that will help. Anyway, for now, I guess the best course of action is to allow the doc to attempt angioplasties and see what happens. I will check to see if he uses medicated stents. As I said, he's still not sure it will work. The blockages I have range from a low of 60% to 95% (in a smaller artery. My right artery is blocked distally up to 80% and my left artery is blocked distally up to 70%. The artery that caused my heart attack was too small to do anything with; I understand this is quite common with women's arteries. Thanks again, I'll write back to the group after the procedure next Thursday as soon as I can to let those interested know of the outcome. I am glad to have found this site, especially if I end up with a bypass sooner or later. Judy
Judy, I would think your age would make you a better candidate for bypass surgery. That's what they told me and I was 60 when I had mine. It has been almost a year now and even though I do have some chest discomfort and numb ankle, I can exercise and do anything I want. The worst part is not being able to eat the foods I like. Ann