I wrote then: "This new blockage was below where they put in three stents in 2007 for a 100% proximal RCA blockage. The good news was that my body had created a sort of natural "collateral" bypass around the new blockage. I was also told on the day that there was evidence of my body creating more "new" vessels around where I had previously had heart damage."
Because I had a history of a LIMA graft (bypass) it was decided the angiogram would be through the groin as this would present the best scenario should it be found a stent or two was needed. This is a whole other discussion for another time.
Left Internal Mammary Artery (LIMA) Graft
The positive side of the angiogram was finding out that both the stents and the triple bypass done at the time of my heart attack in 2007 were all "patent", working well with no issues and blood flow in and around these was good.
My cardiologist who did the angiogram explaining
what he found but I was bit out of it to totally understand
I saw my cardiologist recently to review the results of the angiogram and to try and understand a bit more what the implications of this new blockage meant for me - my cardiologist did the angiogram and is also the same doctor who was on duty the night of my heart attack and who stented me that night. So it would be fair to say he knows my body, particularly my heart, pretty intimately.
I wanted to know more, understand this thing about natural "collateral" bypasses so I asked questions. My doctor explained that in some situations new vessels can generate and create a pathway for blood to flow in and around the heart. He indicated that in my case such vessels did exactly this around the new blockage and he also mentioned there was evidence that similar activity had occurred where part of my heart had "died" the night of my heart attack.
Right Coronary Artery Collateral Circulation
Now I recall being told all this the day of my angiogram, however, still being under the influence of sedation I didn't really grasp what was being said. And I recall on the day being told that an attempt to stent the new blockage failed because the blockage was too calcified, too hard for the "balloon" (angioplasty) to penetrate and allow for the placement of a stent or two.
I don't mind saying that between being released from hospital after the angiogram with the above information and waiting three weeks to see the cardiologist I had more than a few sleepless nights. I mean, here I was having been told I have a new 99% blockage in the mid RCA just below where I had a 100% blockage which caused my heart attack in 2007 and then being told its all okay and you can go home.
So at my appointment I found out a lot more - not only was the blockage calcified and too hard for a stent to be inserted but the mid RCA where the stenosis was located was "tortuous" - a tortuous artery is one that twists and winds in a "tortuous" path - and that part of the artery was less elastic.
Tortuous Thoracic Aorta
I found out my natural "collateral" bypass comprises of microscopic vessels, that these in fact are very much finer than the RCA and that while they allowed for blood flow around the blockage, the amount of blood flow was less than what would normally flow through an unblocked or partially blocked RCA.
However, some blood flow around that part of a blockage in the heart is one hell of a lot better than no blood flow at all!
And in so finding all this out came the understanding of why over the past couple of years I have been having increased episodes of angina related issues - including pressure on the chest, heart burn, left arm/hand tingling, tiredness, lethargy - both "out of the blue" when sitting at the computer and increasingly in recent months when walking, exercising or just exerting myself doing menial activities such as sweeping up around the house.
Being the "chicken" that I am, I rejected the idea of having a full-on angiogram when it was suggested. My memory from the night of my heart attack was and still is very vivid, of how I woke after having stents inserted to find a "sand-brick" strapped over my groin. I was told I would have to lay flat on my back for 3-4 hours without moving and this turned out to be an 8+ hour ordeal due to a thrombosis (blood clot) issue. Remembering this and the deep purple my groin turned to after my heart attack was enough to keep me putting off the idea of having an angiogram.
My groin five days after my heart attack in 2007
However, in April at my annual checkup and after mentioning the increasing incidences of angina type issues - pressure on the chest, heartburn, SOB etc. - my cardiologist strongly suggested I not put off having an angiogram and three weeks later, in mid May, that is what happened.
And I should add that for 3+ hours after the procedure I did have to lie flat on my back before the sheath could be taken out of my groin. And then when they took out the sheath and after 15 mins of the area being massaged they found a small hematoma and a modern, mechanical version of the sand-brick was placed over this. And I had to remain quiet, on my back for another 2+ hours. And I did develop a purple patch but not as a bad as that after my heart attack.
Flat on my back after the angiogram
And here is where the salutary part of the whole discussion comes into play. An angiogram 2-3 years earlier possibly would have picked up the new blockage when it was less developed (less than 99%) and may have been more amenable to balloon angioplasty and/or a stent being placed.
Whilst my doctor could not definitively say when the new blockage started it was clear it was not there nine years ago when I had my heart attack (it would have been picked up then) which means it would have developed over the past 8+ years and because it was so calcified (hard), he felt it would have been there for a while.
So, as I say, the salutary message out of all this for me is that in the future I will listen to my doctor(s) when they suggest something and put aside any petty concerns I might have. It might just be that an angiogram 2-3 years ago would have found the blockage, allowed for stenting and helped me avoid ongoing angina related issues I will now have to contend with.
The outcome of the angiogram given stenting was not possible was that I will be treated medically with an aim to get my bad cholesterol (LDL) down from 2.56 to 1.8 by changing me from Lipitor to Crestor and to do a blood test in three months and if my LDL is still high then Ezetrol will be added to help bring it down. In addition I will continue to use my GTN spray as required as well as continue to take Mononitrate Isosorbide (Duride) and if necessary an additional medication will be added if the angina gets worse.
