Heart attack (Stemi) and unable to stent because of ectatic Coronary artery

[richard_jw]

Last August I had a STEMI. A heart attack which resulted in the complete blockage of the Right coronary artery. When they looked via the angiogram/angioplasty they found that the artery was ectatic. That means apparently that it is not uniform in cross section , and not smooth in end to end shape. They could not stent.

So they did their best to clear it via the angioplasty and anticoagulants.

The following day they tried again because I was still showing symptoms apparently, and managed to get sluggish blood flow through the artery.

Turns out you can survive with a partly blocked coronary artery. The heart muscle it feeds is of course dead, but I suspect that by the time I had been taken into the cath. lab, that would have been the case anyway i.e. the RCA is not relevant, so a stent would not help.

At least that's what the cardiologist says. But I do get what I assume is angina (never had it before MI), and I am assured that the RCA is the culprit. So it seems to me that the RCA is at least doing something useful. I am not on any anti angina meds. because my blood pressure is low (typically 90/65 sometimes and never over 110/70) so I have fainted after taking GTN so I cant take nitrate pills. I have had echo and stress echo cardiograms, and a myoperfusion scan. Current idea is to take midodrine 2.5mg to try to increase BP, and Ranolazine to help angina

In my case nobody seems keen to think about any further intervention angioplasty or CABG because the RCA is of marginal benefit. It would also be very technically difficult. So the risk/reward ratio is poor. In the case of angioplasty, it's not clear what could be done anyway. I'm on antiplatelet meds and bisoprolol and 80mg of statins.

If anyone has any ideas or has had the same sort of issue I would be very interested

[Kristin1812 Heart Star]

Hi Richard. Your heart history is pretty complicated. I saw you had not had any replies yet, and I was wondering why! I’m thinking most of us are hesitant to offer advice with such a picture........and of course not qualified to give medical advice,I wonder if you might (if you haven’t already) call the BHF Helpline, where the nurses will answer what they can, and I’m sure help you form your ideas about possible questions, for when you next see your Cardio team.

[Kristin1812 Heart Star in reply to Kristin1812]

.....cont.........Heart Helpline team on 0300 330 3311 Mon-Fri 9-5pm or email [e-mail]

[richard_jw in reply to Kristin1812]

Complicated it is. Also 2 cardiologists give different opinions about medication. My GP is reluctant to prescribe because he has never prescribed one of the meds, and wants the difference of opinions sorted out as well.

[Kristin1812 Heart Star in reply to richard_jw]

Thanks Richard. Good to hear the Drs are working together to get you the best meds. combination. I hope you get some clarity soon.

[Prada47]

Hello Richard

Join the club I also have a 100% blocked RCA when I had bypass surgery the Surgeon fixed the Circumflex and the LAD , but left the RCA alone !! I have been told the RCA can be opened but it would be difficult and as you say the Reward is not worth the Risk !!

It was in 2015 I was told my RCA was 100% blocked and I have managed fine since then, ok the odd ups and downs but hey still here.

Vaccinated Hands Face Space to Stay Safe

[Platypus6 in reply to Prada47]

Hi Prada I also have a 100% blocked RCA, do you still take beta blockers? The reason for my question is I have problems with them 2 years on from ha.

[Prada47 in reply to Platypus6]

Hello

Yes I take a 7.5mg Bisoprolol and I am on the middle dose of Entresto. I was on 10mg Bisoprolol but it was taking my HR down to the low 30s so switched to the 7,5mg which I seem to manage OK

Vaccinated Hands Face Space to still Stay Safe

[Platypus6 in reply to Prada47]

Thanks Prada that’s helpful .

[Prada47 in reply to Platypus6]

My HA was 1982 Bypass surgery 2015 Further stents 2018. Heart Failure is Moderate EF 40 % so doing OK all considering lol

Vaccinated Hands Face Space to Stay Safe

[Platypus6 in reply to Prada47]

❤️😷

[Asdcymreag]

I had a HA 5weeks ago and was told that right artery was totally blocked, had iv blood thinner for 48hrs and on thinners plus statins, beta blockers and asprin but artery wont repair itself, im worried sick

[richard_jw in reply to Asdcymreag]

Me as well.If the rca is blocked as I understand it that cuts off the blood supply to some of the heart muscle.

That muscle then dies. I don't really understand the exact consequences but once the muscle is dead it does not matter much whether the artery is open or closed.. At least that's what my cardiologist told me.

The heart keeps going but not as efficiently.

One important number is the ejection fraction which is a measure of how much blood is pumped out of the left ventricle to the rest of the body. 65%is good 55% is ok. Which is what I have.

It's measured by an echocardiagram.

So this means that the heart can continue to work after a heart attack where the rca is blocked and possibly not unblocked completely during the angioplasty because they could not.

My case exactly.

I found that the important thing in my case was the absence of NHS cardiac rehab. Because of covid

It's lonely when you are left to your own devices.

If you can sign up for it. I believe small classes are starting up again.

You will never run a marathon but depending on how much damage is done to the heart muscle after the mi you should function OK.