Newbie facing cardiac catheterization

[santisuk]

1st posting on the BHF forum; I contribute to lung and arthritis forums as I have bronchiectasis (mild) and an osteoarthritic hip (managing my way through to an eventual hip replacement).

I felt dead central chest pains 3 weeks ago when out on my daily walk and on the next day's swim; they arrived soon after starting exercise and disappeared quickly when I stopped. I thought they were lung-related so went to see my local pulmonologist at my regional hospital (private) here in Thailand. I'm a Brit expat, retired, 68 and reasonably fit despite my maladies by the way.

He ignored - or misheard - my request for an x-ray and listened to my lung instead, declared it sounded very good, suspected my heart and so gave me an EKG and said that was fine. Ushered me out into the land of potential heart attack (!) with a "come-back-if-it-comes back worse" sign off. [Hang on, what about the fact that i am getting pains that force me to abort my exercise?]

Anyway, that night I had a couple of pain episodes that were unrelated to exertion - also dead centre, that were stronger than the exercise pain and seemed otherwise different in nature; they reminded me very much of the characteristics of pain I had felt during a few chest pain episodes in my 40s. Those had led me to go to a London A&E, arriving for an EKG just after the pain had subsided. The medics concluded 'no heart issues detected - probably acid-reflux. I get a little bit of indigestion/heartburn with sildenafil use (=viagra - day after), but otherwise I had not/have not been noticeably a heartburn or GERD sufferer. Those pains occurred a few more times unannounced over the ensuing 2 years then stopped happening until the evening after my pulmonologist visit.

I did my internet research and clocked that it's hard to tell the difference between lung, heart and acid pains and that heart pain often radiates elsewhere (which mine did not). So I resolved to try taking antacids to see whether I could eliminate or otherwise the acid route as a self-diagnosis test. I took 6 antacids per day over the next few days. I had about 3 other instances of the 'non-exercise' strong pain in the first two days of that plan but over those few days both types of pain disappeared and I was fine. But a few days after stopping the antacids my exercise pain started coming back. When I had to abort a walk after only a few hundred metres I jumped in the car and drove me and my wife the 85 km back to the regional hospital.

Don't try this (any of the stuff I did in the last paragraph) at home yourself children to use the old 'Blue Peter' addage! I should of course gone back much earlier and should have insisted they got to the bottom of my existing pain and I should have let my wife drive - but I always felt entirely normal within a couple of minutes of stopping exertion and the non-excercise pain was not featuring again.

Anyway, this time the duty doctor spotted my pulmo's prior shortcomings (/negligence?) and plumped for EKG, X-Ray and bloods, which showed nothing, nothing heart-related and high troponin blood levels respectively. Straight into A&E, then 3 nights in hospital being monitored, echocardiagrammed and pumped full of anti-coags, betablockers, nitrates, platelet crackers et al and I emerged with an Angina diagnosis (I say 'stable', he says 'unstable' - let's let the cath lab decide). I resisted going to the cath lab in the local regional large public hospital - more people die in there of things they didn't go in with than things they did go in with and I'd get a lung infection just sniffing the air in the car park (joke with a grain of truth)!

I felt good in hospital and even better back home - no pains now on exercise (toned down abit) and most of my osteoarthritic and spinal aches/stiffness seem to have vanished, the latter possibly due to the rest.

So now to the questions, but by all means comment as you see fit on anything you've read on my over-lengthy diatribe.

1. Has anyone flown a distance in between recognising they have angina and being catheterized/analysed? My local regional Thai cardio that treated me said I could fly or drive the 600km to Bangkok if I chose to go for treatment there - "no problem", but was ambivalent about a 12 hour flight to the UK - I don't think he had the knowledge. I will of course ask my chosen interventional cardiologist when I have one. I use Papworth Hospital Cambridge for my lungs as a private patient and the doctoring is outstanding, but the back office support is not up to snuff. It seems the same on the heart side from first impressions (apart from one notably helpful secretary). I'm now at the end of my third day of not getting any answers on consultants available within the next 10 days. My observation is that the culture there is very pro public health services, which I think is laudable, but they need to decide on whether they are committed enough on private care to run with both.

2. Is there any harm in delaying the catheterization for say 3 weeks provided my excercise shows no warning pains and I continue with the heart protection meds. My local guy suggested 'as soon as you can' - again a bit non-specific. I guess that if there are forum members out there who have had to wait for stents on the NHS that long or longer than that gives me some pointers and again I will be seeking consultant advice as soon as I get one.

3. Is it usual to book in on the basis that stenting is done co-terminous with the catheterization procedure or is it more usual that the two processes are handled as separate procedures with some recovery time in between.

4 any observations on recovery times for straightforward outcomes - not much point for planning on the basis of more dramatic open heart outcomes and I'm a think positive kind of guy anyway.

Upwards and onwards.

[Sunnie2day]

I was recently (late April) diagnosed with stable angina and referred as 'urgent' for more investigation (seeing the cardiologist Tuesday 18th June for result of all the tests they've done so far, and I already know just from the cardiology appointment being booked the results are going to be life-changing and not in a good way).

At the GP when the angina was diagnosed I asked about travel - the GP said ok to driving or short-hop flying anywhere here in the UK but absolutely not to any flights to the Continent or long-haul to visit the grandchildren in America.

She said driving or flying about Britain meant if I had a problem (love how she called potential heart attack 'a problem') medical care was reasonably within quick reach but flights lasting more than two hours were out as medical care in an emergency would be difficult to access. She also said something about cabin pressure possibly causing 'a problem' but honestly my brain fogged over when she said no long-haul and I didn't really catch what all she was saying about cabin pressure.

Considering you're in need of further testing, and the medic said 'as soon as you can' (meaning get in there quick time), I can understand your being told driving to a centre would be ok - if you had a problem you could reasonably expect to reach medical care quickly. But I can also understand his ambivalence agreeing a long-haul (because what he really meant was 'not advisable, please do not take the risk').

Sure, it would have been better if he'd come right out and said you need to book in for those tests on an urgent basis, and if he'd said absolutely not to long-haul but Thai people, even medical professionals, don't work that way as you probably already know from having lived there for a while. He definitely has the knowledge but also has the Thai cultural tradition of extreme politeness in professional settings (my experience with many Thai people) and would have been reluctant to be what he would consider too forceful. Clearly he thinks you need those tests 'as soon as you can', but thinks you have a bit of leeway regarding where you test. All respect to Thai medical professionals - if he thought you were in imminent danger he would not have hesitated to be as forceful as required by circumstances.

[santisuk in reply to Sunnie2day]

That's brilliant Sunnie2day. Just what I needed - someone who has been there and done that.

Very timely too. I literally just put the Skype phone down (figuratively) having tried in vain to contact Papworth again to finally press them on whether they could accommodate my request for treatment within what was 10 days when I first enquired. Nobody was answering the private patients helpline so as a result of your post I'm blowing that one out and will see if i can get an appointment with one of the Bumrungrad Hospital Bangkok interventional cardiologists, several of whom seem to have done 2 or 3 years in 1st world cardiac units.

My experience with Bumrungrad for other issues is that you can usually phone up in the morning and see someone well qualified by close of play! different world, but an expensive one of course - Thailand is no longer a cheap medical tourist place.

You are of course spot on with the Thai cultural aspects - not quite as "what answer do you want" as the Japanese, but definitely ones to take the hard edges off when managing customer expectations. A Bumrungrad spine surgeon did my prolapsed disc last year. He was so proud of his microsurgery work that he told me on release that I could walk normally now - this was 24 hours after the operation. Indeed I could walk fine around the hospital bedroom and when getting back to our Bangkok condo by taxi. Decided to take him at his word and walk to a restaurant round the corner half a km in the evening and when I arrived thought I had completely unravelled all his work. Had to take a taxi back and was sore/concerned for a couple of days.

I live in the depths of rural Isaan btw. Very many thanks again and hope your results go better than you're expecting.

[Sunnie2day in reply to santisuk]

Thank-you, and the same to you - please update this after your cath!

[santisuk in reply to Sunnie2day]

Will do!

[santisuk in reply to santisuk]

A Papworth consultant has just e-mailed me 2 hours after your response, with a very British version of my Thai guy's indirect way of getting the message across.

'It does look as though an angiogram is required.

Do you really wish to come all the way back to the UK for an angiogram?

The airlines would have an issue with you having had a recent troponin positive event'.

Papworth's back office finally got its act together. Nice to know, since I'll be back there for my lung review as soon as I am clear to fly.

[Sunnie2day in reply to santisuk]

Good to hear the UK unit did get back to you, and yes, our British doctors are a bit more direct although not as directly (read brutally) direct as German ones - they don't dance around at all!