How do we get a second opinion? - British Heart Fou...

British Heart Foundation
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How do we get a second opinion?

My Dad had a triple heart bypass 12 years ago.. Then in October 2018 he got extremely breathless, tired and suffered extreme chest pain which lead to him using his spray more in the past 3 months than the last 12 years. After lots of mess up with appointments my Dad finally had his angiogram yesterday and it showed the 3 arteries that were bypassed 12 years ago have issues. One is totally blocked, one is partially blocked and the other has collapsed. My dad was sent home and told that they would be making an appointment to stent the collapsed artery and that they do not plan to do anything with the blocked and partially blocked artery unless he has any angina after the stent in the collapsed one. How can this be the right thing to do it sounds crazy to me and I want a second opinion, please help?

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What is your father's view of the situation?

I suggest your dad goes to see his GP to discuss the hospital's plan of care and the GP can then refer your dad to another Cardiologist to review your father's case if that is what your father wants to do.

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My Dad is worried as he has a blocked artery and a partially blocked artery that they are not going to treat unless he carries on with his angina. He told me his angiogram was extremely painful and apparently it is not meant to be. He told me he was not confident with the cardiologist. His cardiologist hardly spoke to him and did not explain or talk him through why they were not doing anything with his other two arteries. I think the issue here is communication...

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I'm not in any way trying to dissuade you from seeking a second opinion. However, there may be reasons why the cardiologist's plan could actually be your dad's best option.

It could be that only one artery is suitable for stenting, it's common in a triple bypass that one artery uses the mammary artery, where as there other two arteries use a vein from the the leg. The mammary artery is incredibly tough and long lasting, the two leg veins tend not to perform as well when asked to do the more demanding duty of an artery. I don't know the detail of your dad's case, but they may now simply be too far gone for stenting?

It could be that the next option after single artery stenting is another bypass operation, you don't say anything about your dad's age or general health and fitness, but maybe these are also factors in this calculation?

The next step should be to share your concerns with your dad's GP and ask for a more detailed explanation of the recommendation. If you still want a second opinion after that then here are the NHS guidelines for requesting a second opinion,

nhs.uk/common-health-questi...

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I tend to agree with Chappychap, Comorbidities like diabetes and asthma, age, general fitness can all affect the decision to perform a bypass whether the first or second time. Also a donor blood vessel(s) is/are needed - issues like PAD and varicose veins could affect this.

Speak to your GP as suggested. I have suggested to others they arrange a private consultation with a cardiologist but before spending your money you need to feel that you will get something out of it.

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I think the other 2 arteries are too far gone for a stent. My Dad is 65 he does not have diabetes, he was active with work and he could be fitter. He is currently not able to walk anywhere without getting out of breath or using his spray... I just don't understand why they won't do anything unless he keeps on having pain. I will book an appointment with his doctor with him to discuss then go from there. Thanks for your response x

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Hi, like others are saying speak to his GP but I just thought you would like to know & it may reassure you to know my husband has lived with a totally blocked aorta for 21 years. It can't be unblocked & it can't be by-passed so he's been treated with medication all this time.

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My husband had a CA and was stented, the cardiologist at the time informed me that other arteries were too damaged to stent. The cardiologist at my husbands follow up initially denied this had been said, however, having checked my memory with our daughter I asked again at the second cardiology appointment. At this point we were told nothing would be done about the other arteries unless my husband became breathless or started to suffer with angina, at which point they would consider “further options”, by which I presume they mean a by-pass. Husband is 63, and had undiagnosed diabetes and a family history of cardiac problems. Hope this helps you not worry that your dad is being side-lined, however if he is breathless and in pain follow guidelines to see another specialist, go to your GP and discuss the suggested treatment and get another referral.

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Thank you I appreciate your response. I think it would have helped if the cardiologist explained it all in the first place. Unfortunately I had just missed the cardiologist when I went to pick my Dad up after his angiogram he was quite upset so he forgot to ask questions. However if it was explained why they were not treating the other arteries in the 1st place it would have helped us to understand.

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As patients we all expect to be treated with respect and dignity and of course kindness and compassion.

This expectation is written in the NHS Constitution along with the words that it is our right.

I suggest you contact PALS and tell them how your dad and you feel about his experience as a patient.

How the lack of communication has affected you both.

Ask for a meeting with the Cardiologist concerned with the Head of Department present so your concerns can be discussed more fully.

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It’s a learning curve for both of you and your dad. He needs someone with him to ask questions and to make sure everything is understood. I don’t trust my husband (same age as your dad) to go to appointments on his own, he never asks the right questions and he forgets to ask stuff. Although we now make lists before important appointments.

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Ring the hospital back and speak to cardiologist secretary, ask for another appointment as it is not clear to you or your father what the next action is, GP, only will have a report on the procedure and overview of condition. Hope this helps.

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Your Dad may not have diabetes purely because he has high insulin levels masking potentially high blood glucose. Dr Kraft found three-quarters of his patients had abnormal insulin responses and concluded that chronic heart disease is underpinned by (often undiagnosed) diabetes in situ AKA insulin resistance phcuk.org/wp-content/upload...

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My husband has one blocked artery and one 50 percent blocked,they are not stunting the blocked one because they said the 2 remaining ones are doing ok, he,s on bisoprolol gets tired but is active, he is 69

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Happy to see a doctor has taken a non bookish decision.normally they are happy to do surgery as a first choice as per their training.for my case I took second opinion to convince doctor I shall be fine without surgery .. All depends on angina situation

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Hi Miss Dancer

I have a 100 % blocked Right Coronary Artery it is possible to attempt unblocking, But the Cardiologist says it's not worth the risk trying to open it. The reason being that the area of heart muscle that it supplies is termed Non Viable i.e. opening the RCA would make very little difference to the working of the Heart Muscle I am a 71 Y.O. I had by pass surgery in 2015. Has Heart Failure not been mentioned in relation to your father being short of breath, It some times follows that people have that diagnosis after long term heart related problems.

Best Regards

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Go to your dr and say your not happy and you want a second opinion. There's also a place in the hospital where you can write to and say your not happy. My daughter was in hospital and Drs weren't doing anything fortunately I have a cousin who told me tell the hospital your not happy with them and if nothing's done then go to the papers they don't like the mention of the papers. This cousin is a retired nurse. I did what they told me and my goodness everything moved qouickly after that next morning at 9 (think it was) they took her down to theatre and was fine. I also put a letter in to patients advisory and they moved quickly too hubby and I had meetings with the dr as well as the head if that dept.

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The instinctive response of patients is naturally 'if there's a blockage stent it'. For cardiologists the aim is to see first whether the blockage is causing the angina. Your father's cardiologist considers that the most likely culprit is the collapsed artery and will stent this. If your father still has angina after this the cardiologist will revisit the situation, so it's clear your father will not be abandoned with angina. There is no point in unnecessary stents if only one artery is the cause of the problem.

I agree there is a communication problem and the cardiologist could have given a fuller explanation, but I also have some sympathy for doctors who don't answer the questions at the appointment which patients only think of later! They're not mindreaders and patients need to communicate too!

You need your mind put at rest as well, but I don't think the answer is a second opinion elsewhere, where another doctor would not have access to the angiogram.

You may find the cardiologist's letter to the GP makes things clear, if not get in touch with the cardiologists's secretary and explain your dad is worried and doesn't understand why all the blockages are not being dealt with at once and forgot to ask this at the appointment. I'm sure he will be happy to give an explanation.

If you are then not happy with the cardiologist's decision you can ask through PALS for an MDTA meeting ( multidisciplinary team assessment) to see if they agree with the decision.

I don't think this is a complaint / second opinion problem. I think a couple of the responses are overkill and I don't think there's any need at this stage to involve PALS or demand a meeting with the head of department.

Your father's heart disease has progressed which suggests he could do more with diet / exercise / cholesterol management. Bypasses only deal with the immediate problem, it's lifestyle measures and medication that actually treat atherosclerosis.

All the best to you and your father

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