Angioplasty tomorrow...in urgent need of advice asap pls

[DizzyD]

Hi all angioplasty booked for tomorrow but not sure if I should go ahead with it or just cancel. Reason for procedure: Doc wants to investigate extent of artery blockage in order to prescribe flecanide medication for afib. If blockage is severe he will fit a stent during the procedure. Got quite a shock when pre-op consult nurse told me I could be having a stent fitted during the procedure to investigate extent of artery blockage. Anyway I see the logic in going ahead with a stent of needed.

So here's were I need some advice. Last night I had horrendous AFib attack. HR was so strong pounding in my chest, fitbit revealed I was in peak cardio exercise mode for 11 mins, then came powerful chest pain and pain middle of back below shoulders. As if that wasn't enough also got pain in jaw an face. Very weak, could barely walk or talk due to breathlessness and everything else that was going on. Be it right or wrong instinct drove me to sit in bath and spray cold water over my body which I managed to do. HR did slowdown and some of the symptoms mentioned above were not as intense. Been in AFib all night and still in it now. I do normally, have A fib attacks that can last for days. Honestly, I feel so battered, vulnerable, weak and very uncertain about going ahead with the PCI procedure tomorrow.

Also was prescribed Lansoprazole stomach med, to help with possible side effects of pre-op aspirin and Clopidogrel. Since taking just one dose of Lansoprazole 5 days ago I have continually had stomach cramps, excess flatulence and constant diarrhoea. which are side effects of Lansoprazole so there is no way I could take it again. My digestive tract is in a mess post one dose of Lansoprazole so have no idea what will happen if I take 8xAspirin and 8xClopidogrel.

Considering the above should I go ahead with procedure tomorrow or cancel it?

Thank you most kindly for taking the time to read my post.

[SeanJax]

not only go for the procedure and also go straight to A&E now. Chest pain during Afib is an emergency. Enough of Dr. Google. Go

[DizzyD in reply to SeanJax]

Dr Google who is he/she? No seriously I always have chest pain with afib, my cardiologist said it was normal symptom. Last night it was more severe though. Think I am ok now...AFib finally gone just left with slight pressure, ache in chest only. Just resting on bed.procedure for tomorrow been cancelled. Told I would not be allowed on the ward with diarrhoea.

Sincere thank you

[mjames1]

"Powerful chest pain, difficulty, breathing, radiating pain" I would head to the A&E now and contact your doctor.

Jim

[DizzyD in reply to mjames1]

AFib stopped, symptoms gone, apart from slight tightness and ache in chest. Think the crisis is over. Don't relish going to a+e with such minor symptoms. Likely to be there for 12 hours. Resting in bed...pretty weak after the ordeal. Thank you Jim

[mjames1 in reply to DizzyD]

Certainly way above my pay grade, but the symptoms you described are consistent with a heart attack although of course it could be many things. I hear you about not wanting to go to the A&E now that the crisis has passed, but you should at least alert your doctor as he may want to run some blood tests to investigate. It may or may not affect whether they want to do the angiogram tomorrow, again beyond my pay grade.

As to the stent, recent papers show no benefit to stent versus statins and lifestyle changes in those with significant stenosis but asymptomatic. Something you also may want to discuss with your doctor. But whatever you decide, please inform your doctor in detail what happened last night. That is not normal for an afib episode.

nih.gov/news-events/news-re...

[DizzyD in reply to mjames1]

Sound advice Jim have no idea how to contact my cardiologist but my daughter did contact his secretary today and ran diarrhoea issue by her hence my appointment has been cancelled for tomorrow simply because I would not be allowed on ward with diarrhoea. My daughter did not tell Secretary about the AFib and all the other symptoms I had last night of which my daughter did not observe. Today, she saw me symptom free, apart from slight discomfort an tightness in chest an feeling rough an weak after AFib ordeal.

Agree with you that symptoms are consistent with a heart attack. Had these symptoms along with AFib many times but last night they were much more severe. In all honesty don't know how I survived.

As for the stent issue, my cardiologist never mentioned a stent. He told me he was doing the procedure to evaluate the extent of the blockage in order to prescribe flecanide. In copy of letter he sent me he stated that flecanide was controversial in my case. In other words I can only be prescribed flecanide if there is a fair amount of blood flow in the blocked artery. Hence the procedure....cardiologist never mentioned anything about possibility of a stent which is why I was shocked when pre-op nurse mentioned it last week.

Not sure if any level of troponin (spelt incorrect) will be detected in blood 32 hours after heart attack, but still am going to a+e tomorrow morning.

Thanks a million Jim

[mjames1 in reply to DizzyD]

Unfortunately, sometimes the patient is the last to know they got a stent, because they are unconscious at the time! It is therefore imperative you have the "stent or no stent" discusion (yes/no/if yes, under what conditions, etc) PRIOR to the angiogram because again, during the procedure you may be out cold. You also have to speak directly to your doctors and let them know what happened last night. The fact your daughter didn't observe it, does not mean it didn't happen. The good news -- maybe-- is that this is not the first time you had these intense pains in afib. The bad news -- maybe -- is that you are having these intense pains while in afib. In any event, the docs must be informed.

Jim

[Weren in reply to mjames1]

I was not unconscious during my angioplasty and they put in 2 stents. I wish I had been unconscious, but was told you need to be conscious during the procedure.

[mjames1 in reply to Weren]

Glad things went well, and be happy you were conscious. The less anesthesia/sedation, the better for your health, especially when you get older. Here in the States, they tend to over sedate, therefore my prior advice to speak to your doctor prior to the procedure, as you might be unconscious during the procedure.

Jim

[Weren in reply to mjames1]

My anxiety level runs high and it would have been nice to have been sleeping. It turns out the power went out during my procedure at the hospital that day 😯! Also later the same day is when I was diagnosed with AFib.

[DizzyD in reply to Weren]

Oh heck so A fib diagnosis after having stent implant!!!! Scary stuff. My anxiety level not that great any more...it would help if was given some form of pre-op tranquilizer to help deal with the anxiety considering one is awake during the procedure.

[Weren in reply to DizzyD]

I was given pre-op meds, but evidently wasn't enough. I was shaking during the procedure and they gave me more, but that's me.

[DizzyD in reply to Weren]

You were given pre-long meds Weren? Like what? I wasn't given this option. Don't think I would have needed any pre-op meds for angiogram procedure but when pre-op nurse said I was having a stent put in I was shocked. Would defo want a pre-op if I go ahead and get procedure done in the future. My procedure was cancelled..phew what a relief. How are you now after the procedure?

[Weren in reply to DizzyD]

My procedure was done in 2014It was a last resort after 3 days being in the hospital after passing out on my face. 1 stent was placed in the mid coronary artery and the 2nd stent prox RCA 3.

As I stated that day I was diagnosed with AFib. AFib was not new to me at that time I just didn't know what it was. For me that was normal.

In 2008 I had a left carotid artery surgery. My AFib is now mostly 5 days a week now.

[DizzyD in reply to mjames1]

Just an update jim. Took everyone's advice and went to a+e yesterday. Did not have a heart attack however troponin (incorrect spelling) level was 20 which went down to 19 after second blood test. Just wondering if level would have been higher if I was tested Sunday night when episode occurred. A+e doctor sent e mail to my cardiologist so he has now been informed. I certainly need to question stent issue with doc, which in my opinion was never discussed. Stent versus statins debate? I don't take statins perhaps I should. By the way...I will be conscious during the procedure, if I have it in the future.

[mjames1 in reply to DizzyD]

Glad no heart attack, but sounds like at some point you need a better plan/meds to ride out these episodes.

As to the stent/angioplasty topic and the new study mentioned. To get definitions straight, both angioplasty and stents are used to open up clogged arteries. Angioplasty with a balloon and stents with a small mesh tube. When they do an angioplasty, stents are often used as well. There is also an exploratory procedure called an angiogram, which checks out blockages. During an angiogram, they may do angioplasty or place a stent, or they may not, depending on what they find and treatment approach.

The trial I referred to is the ISCHEMIA trial. I have linked a paper discussing it below. In short, the Ischemia trial suggests that a medical approach (statins, etc) works just as well as stents (and even bypass surgery) for those even with significant blockages as long as their blockages are "stable". I have also read the same applies to angioplasty, and for that reason, the utility of angiograms themselves are questionable the stable population, because if you're not going to stent or do angioplasty, what's the point of an angiogram?

Certainly worth a discussion with your cardiologist before your procedure.

mail.google.com/mail/u/0/#i...

Jim

[DizzyD in reply to mjames1]

Hey Jim could not find anything about ISCHEMIA trial in the link you so kindly sent me. Just re-read letter from cardiologist which clearly shows why I believed I agreed to angiogram procedure to determine degree of blockage in the artery, in order to be treated for AFib with Flecainide.

Quote from cardiologist letter to my GP "The use of Flecainide is controversial but could be argued if there is no flow limiting coronary disease"!!!! I do have some flow limiting CD so why did he say "No" flow limiting CD?

He goes onto say: Patient agreed that she will go forward for left heart catheterization plus pressure wire assessment.

No mention what so ever about stent!

Anyway whatever I decide "angiogram" procedure can be done in May. In the meantime started taking statins.

Can you please check out the link you sent me and confirm if is the correct one.

Much appreciate your help

[mjames1 in reply to DizzyD]

First, sorry about the link, so I'll include another at the bottom of this post which hopefully will work better.

So, it seems your cardiologist is a little skittish about flecainide and after all it is a powerful drug that should be used selectively. That said, the usual protocol for selecting candidates is an exercise stress test and/or echo. In general, an angiogram seems a bit unnecessarily and heavy handed, although all cases are different. So, if that's the reason for the angiogram, I'd get a second opinion from an electrophysiologist (ep) who are more familiar with flecainide and might guide you better.

Back to the angiogram which you might not need. Angiogram can be exploratory, but often they sent and/or do angioplasty if they encounter something. As mentioned before, that may or may not be something you want, so always good to have that discussion before.

Here's the link:

health.harvard.edu/blog/med...

Jim

[baba]

You need to get URGENT medical advice NOW. Don't wait till tomorrow.

[DizzyD]

Sincere thanks

[Bagrat]

Do hope you have sought medical advice by now. I know we all have a "normal for me" with Afib but what you describe is also normal for a serious cardiac event so get it checked ASAP.

[Jalia]

I can't believe that you did not go to A&E with the symptoms you describe. For goodness sake these are all the symptoms of a heart attack. What were you thinking getting into a bath with all this going on FGS ?!

Do get along to hospital tomorrow without fail and give full account there. Personally I would say that you should be at A& E now !

[Buffafly]

Lansaprazole had the same effect on me - I took it for a week then had to stop but diarrhoea continued 😩

[DizzyD in reply to Buffafly]

I took one dose and all hell broke loose. No pun intended. Have no idea what it done to my digestive system but I do know stool was a mass of string like strands along with very distinctive undigested food. Think it's cleared up now.

[Buffafly in reply to DizzyD]

🤢 I ended up in hospital in isolation because they thought I might have caught CDiff in the hospital where I had my ablation. Turned out to be diverticulitis but put me right off the ‘zoles’.

[DizzyD in reply to Buffafly]

Never heard of CDiff Buffafly!!! 🤔 Hope the diverticulitis has cleared up now. If I do go ahead with with the procedure in the future been told not to take the 'zoles'. Downside of that don't know how the 8 aspirin will effect my stomach because digestive system still in a mess after only taking one 'zole'.

[Tapanac]

could you ring the consultants secretary and get her to ask him. I do hope all will be well