I had NSTEMI in March 2022 (identified through raised troponin of 42). It was completely unexpected. Except for high cholesterol (Total 6.9, LDL 4.9, HDL 1.3,), none of the risk factors were applicable. There were no symptoms until one day I experienced pain on exertion. I was referred to a cardiologist who asked me to get CT angiography done. It showed 99% LAD occluded, 50% distal RCA stenosis, and normal .circumflex. They stented LAD the next night and since put me on the normal cocktail of medicines. On one year check, exercise test results were excellent. Due to statins, my cholesterol is excellent (total 2.75, , LDL 0.9, HDL 1.2). I have remained disciplined in terms of regular exercise (walk 5 km daily and 3 times a week in the gym strength training), medicines and diet (no meat, no processed food).
So touch wood, since the stenting procedure it has been mostly trouble-free. However, I know that CAD is a progressive disease. So, my question is what has been the experience of people here in terms of remaining trouble-free? How long have you managed or are managing to remain trouble-free? it is dreadful to live under the constant reminder that an event can happen anytime.
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cgpt
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it seems like you have taken appropriate steps in managing your health after experiencing a NSTEMI in March 2022. It's positive to hear that you underwent CT angiography, which identified the occlusion in your left anterior descending artery (LAD) and the stenting procedure was performed. Additionally, your exercise test results were excellent and your cholesterol levels have improved due to the statin medication.
I had the similar conditions and had been administered 2 Stents in Feb 2020. even after controlled diet my triglycerides was always high and the doctor changed medicine . Please continue what you are doing and visit doctor once in a quarter.
Do not stop medicine, I did it for some time which resulted into increase in Lipids.
Do not think too much about it. Go for meditation and keep your self engaged. No worries and stress is the key. Stents have already given us a lease of life. So, Enjoy. Good luck to you.
Thanks. I am going to stick to my lifestyle of exercise, diet and medicines. I also work full time in a challenging (not physically) job. That keeps me mostly focused and helps to be distracted from health concerns. It is just that it seems like a hanging sword that anything can go wrong anytime and no one seems to know when.
Dear CGPT, it is fact of the life that it has to come to an end and no body knows when. But, let me tell you with stenting your heart is now younger and with the regulated and self disciplined life style, the life expectancy has increased. Please do not let this deteriorate thinking about the event which is going to happen otherwise also. Please be positive and enjoy every moment of life. One way to feel better is to be with old friends and youngsters.
Let me share you my experience, me, my wife, my son and my daughter in law are living together and spend some time together every day. Week ends are for outing together alongwith mother of my daughter.
I meet my old buddy every now and then.
After stenting I took up a freelancing consultancy where income was not even a tenth of my previous earning but happiness quotient has increased tremendously as I was always with a group of 3-4 Boys and girls of 18-21 years.
At the end, again, my request, not to think about the D-day or untoward happening which may not happen at all.
lots of good experience shared there. I am not worried about the longevity but the quality of life.
I take your very well articulated advice. Best to focus on day to day life, take one day at a time and live life without overly concerning about something that may or may not happen.
My husband had a stent inserted in 2011, his family has a strong history of heart disease. One of his coronary arteries was nearly completely blocked.His brother survived an out of hospital cardiac arrest following a heart attack.
Their father died in his 50's from a heart attack.
My husband takes tablets, we eat a heart healthy diet.
Then it's a case of enjoying life.
I also live with a very unpredictable rare kind of angina that takes me into hospital at least once or twice a year.
It's a gallows humour approach in our household.
We concentrate on the positive which is seeing our 3 adult children thrive.
There are various strategies that you can adopt to help with the anxiety of living with heart disease.
My local hospital offers sessions with a Cardiac Psychologist as part of the Cardiac rehab service.
Hi - Thanks for your post. In my case, they did a telephonic cardiac rehab and was highly unstructured. These were group sessions using Microsoft Teams. One of the guys was very disruptive, challenging everything the rehab team would say. No one could control him. Even otherwise the sessions were of not much value - I guess due to the remote nature. There were also technical issues in getting the online meeting started, audio/video etc. So, short answer is I really don't have access to the Cardiac services you mention.
Thanks. I get when you say 'hard to believe that it happened'. I am otherwise quite fit and have become fitter since the event. Now I am on aspirin, statin and low dose bisoprolol. They stopped Ticagrelor after 12 months as planned.
Everyone is different I know people who had one over 20 years ago and still around in their 80’s and others who are living lives to the full my hubby wasn’t quite as lucky he had 2 in 18 months and then got symptoms 6 months after the second where luckily he got another stent preventing at that time a third. That stent was placed in April 2021. He never has more than a fleeting thought about it. I worry more than he does. He has always walked, rarely drinks and never smokes so he is doing all he can . Enjoy this lovely Summer.
Today is the tomorrow you worried about yesterday and all is well -(sign in our loo)
Hi cgpt,Sadly my heart problems were genetic, so nothing I did caused it. I had 3 heart attacks and 2 stents, both of which failed resulting in me having a double cabg in January . I hope you will be trouble free forever but heart problems are not just related to poor lifestyle choices, they can be caused by genetics and hereditary conditions. People who are fit and athletic, don't smoke or drink and eat all the right foods can have heart disease and high cholesterol. We can only look after ourselves as much ad we can and hope it's enough.
Yeah that's a good point about genetic issues. Another factor that the cardiologist emphasised upon was stress. Modern busy lifestyle can induce a lot of stress. If not managed, it can cause a lot of harmful effects. They equate stress with smoking 10 cigarettes per day.
It's 5 years since mine. I was told I had 2 more blockages in the LAD that were 64% blocked but not bad enough to stent. That's now left me very anxious to know how those two are progressing. Despite being very breathless I'm finding it impossible to get a GP to take it seriously. I see a different GP every time so no one ever follows up, They've checked lungs with x ray - clear; I'm waiting for a spirometry test which I know will be good, I had an echo and a holter monitor at the start of the year but they simply won't send me to cardiology.Because I used to smoke and also have extremely bad spinal problems, they only think of lungs or a muscular problem which is exactly what the GP said 5 years ago when I complained of breathlessness. How wrong he was. I just want to know if things are ok. I completely understand the hanging sword. Could you please explain what happens with a CT angiography? Is it less invasive than an angiogram?
Sorry to hear of your troubles. It is unfortunately so common that possible heart conditions are misdiagnosed in the first instance.
Yes, CT angiography is a less invasive version of the traditional angiogram. The main difference between the two procedures is that while a standard angiogram involves a catheter being inserted into the artery and to the area being studied, a CT angiogram does not require the insertion of a catheter.
Utilising state of the art computer tomography scanners, it checks the arteries supplying blood to the heart, and can be used to diagnose conditions such as coronary artery disease (CAD). Using detailed images of the heart and blood vessels, a CT angiogram can accurately highlight any narrowed or congested blood vessels.
However, if CTCA results are positive e.g. one or several blood vessels being blocked or narrowed then a standard angiogram may be required as a follow-up.
Thank you ever so much. That's what I thought b ut it's great to have it confirmed. I wouldn't mind at all having an angiogram if stents were required but the risks are too great for just checking. Now to try to force my GP into doing something. The last one I spoke to tried to insist angiogram was the only way.
good luck. I was really scared of all of these terms/procedures having not seen inside of an hospital for several decades and no family history of cardiac problems. However, CTCA was relatively straightforward. A dye was injected into a vein in my arm. They also injected beta-blocker to slow down the heart rate and blood flow using the same canula. Apparently the dye highlights any blockages in your coronary arteries, helping to diagnose coronary artery disease. Overall, I think it took an hour - prep, scanning and recovery.
That's far better than having an angiogram. I couldn't have cared less about my first one because I'd just had the heart attack and didn't have time to think about it but when I had to go back for a second one, I was a wreck. The two blockages were simply brushed off but that leaves you in limbo constantly worrying whether they've got worse or whether your lifestyle is affecting them. I don't get any exercise because I'm in a wheelchair and I wasn't even allowed to have rehab so even now I'm not sure what's safe to do.
sorry to hear that. It seems that the current hypothesis is that high-resolution CTA is not inferior to cardiac catheterization for identifying significant CHD. So I am not sure why a cardiologist would insist on angiogram and not allow CTCA unless there are other factors such as known allergy to the contrast media (dye) or other medical conditions that are contra-indicated.
I would suggest you ask for the clarification from your cardiologist when you get to see them next. There must be a way to do exercises while in a wheelchair. You may want to talk to BHF nurses or look at for example youtube.com/watch?v=QZvlY_7...
I never thought a CT scan was less good but my GP just didn't seem to know there was such a thing. She just said the risk of an angiogram was best avoided. Now I know the scan exists I will push for one. I've had several normal CT scans; no problem with the dye at all. Just not keen on the bisopralol . It drops my BP so low I can't get out of the chair. LOL. Think I'd manage a day though.
OK thanks. Well my normal is between 80 and 90 so they probably would. I have to get there first LOL and the sooner the better. This week in the heat has been awful. Pulse of 120, BP very high ( gone down now it's cooler) and feeling absolutely dreadful with chest heaviness. I'm on several meds that reduce electrolytes magnesium and potassium so I need those checking
Out of interest, because I am where you were; CT angiogram suggests mid LAD 90% blocked but I am reluctant to have an invasive angiogram or stenting. Do you think you would be in the same place now if you hadn’t had the stents? Ie meds, diet and lifestyle would be enough?
To some extent, I didn't have a choice. When I did CTCA, I had severe angina symptoms on minimum exertion i.e. pain/breathlessness when walking. I could barely walk for 50 meters and the symptoms would trigger. It was all of a sudden. So I didn't have these symptoms for more than a couple of days. And after the angioplasty and stenting procedure was performed, it magically disappeared from the next moment.
So, if I had a CTCA even a couple of weeks before then I may have been in your situation with a decision to make because I didn't have any symptoms. I was really lucky that I was under the care of an excellent cardiologist, who got me admitted straight away on CTCA and listening to my symptoms and perhaps that's why I am here to tell the tale.
Knowing what I know now and having lived the experience, and since you are asking me my opinion, I would say you have the pre-warning, you have a chance. Hence, you should seriously consider angioplasty and stenting at the earliest to hopefully prevent a significant cardiac event. A major cardiac event can cause severe impact on one's life.
In all cases, please follow medical advice and your own judgement.
Have a look at the ISCHEMIA trial results.It's not what you might expect.
In stable angina stents can improve quality of life by reducing symptoms but not necessarily major adverse cardiac events.
During an acute coronary syndrome, ST elevation Myocardial Infarction STEMI, caused by a complete blockage of a coronary artery then stents can be life saving.
"The ISCHEMIA trial failed to show that routine invasive therapy was associated with a reduction in major adverse ischemic events compared with optimal medical therapy among stable patients with moderate ischemia."
There is also growing evidence that some patients have ongoing angina after stents are inserted and even after by pass surgery.
Well that's the question that is being increasingly asked by Cardiologists, when to stent and when not to stent, especially when someone has no symptoms.It seems it is becoming more dependent on how the blood flows not necessarily how blocked a coronary artery is seen to be. In the past it was see a blockage then stent it.
Let's say there is a lively debate going on amongst Interventional Cardiologists 😊
For all those fellow research nerds.
The European Society of Cardiology published these recommendations of how to manage those with chronic coronary syndrome.
My cardiologist initially had prescribed medicines + lifestyle. However, the very next day when the symptoms got worse and looking at the CTCA results, he decided immediately do the stenting. There was no choice.
If Inion does not have any symptoms at the moment and if medicines + lifestyle changes are shown to bring the required improvements then they may not need invasive procedures. There is a hypothesis that in some cases stenting may, in fact, have placebo effect and may not actually have any impact on improvement in symptoms and/or the medium/long term mortality outcomes. However, when you have clear and severe symptoms/cardiac event and the CTCA results show severe blockage, then angioplasty/stenting is no brainer.
So, in Inion 's case, I would go with the cardiologist's recommendation.
Me too if it was needed and the only option but GP doesn't seem t o think so. Slightly off putting, a friend had one just last week and during it the wire bent back and was extremely painful. Cardio's fault and he apologised. NO damage done but it scared her.
Hi, I am reluctant because I am petrified of having such an invasive procedure and having a stent sitting in my artery. It just seems like an extra risk when I may indeed not have an event. Also I am afraid that if I were to pluck up the courage to go ahead, I will be so stressed that I will bring on the event myself anyway. Irrational maybe, but I have also read of the findings that Milkfairy mentions, so as I have no significant symptoms as yet, and my risk of a major cardiac event will not be reduced I find myself between a rock and a hard place. It is helpful to have found this forum and to hear how well folk like you are doing since having stents as I don’t know anyone first hand with this experience.
I personally know now dozens of people firsthand who have benefited from angioplasty and stenting. In almost cases, life has improved significantly i.e. almost back to normal. Now I am not sure how much that is down to the placebo effect.
Fully understand your perspective though. And I am not sure what I would have done if I was in a similar situation. In my case, the situation turned out such that I no longer had a choice to make.
Can you please clarify what's the advice of your cardiologist and have you discussed your concerns with them?
My cardiologist says that the CT angiogram isn’t as accurate as the invasive procedure so booked me in for this, although I had no notification of this apart from the letter inviting me to the pre op assessment. I phoned to cancel this but the cardiologist said to attend anyway and he will chat with me about it. I did and am still not sold on the idea. He said if the angiogram shows the same as the CT he will recommend a stent which will be done at the same time, but, then again, maybe it won’t be necessary. For him it is routine, I guess, for me, it is beyond frightening. I feel that he lacks empathy which I find disconcerting. I guess I am seeking reassurance. I live alone and have nobody to talk to about the situation which adds to the anxiety that I am experiencing. Thank you for your replies.
I completely get you. When I first went to the cardiologist, I did not even believe that I had a heart issue. He also perhaps did not believe I had a serious issue (since I had no apparent risk factor other than high cholesterol) until he saw my ECG. He booked me for a CTCA and echo for the next day. Rest as they is the history mainly due to my symptoms aggravating. It all happened at a fast pace and was certainly beyond wildest imagination at that time. When the cardiologist first said the words like stent etc I was petrified. In a way, I find that the pace of the things took away the anxiety of decision making from me. And the pace at which the symptoms aggravated, I am thankful that I am here to tell the tale.
I also found that though the cardiologist is excellent in his profession, for them it is a routine matter. Hence, for a new patient the communication does feel devoid of empathy.
I suggest you do consider the pros and cons very well. In case your symptoms aggravate suddenly (I hope they don't) then it may be far worse situation than doing something in a proactive manner. It seems that performing an angiogram is a reasonable workaround and he may then do stenting only if it is really needed. But you do need to weigh the pros and cons for your situation. Good luck.
Hi there CPGT, I've had three events. 2 STEMIs and 1 NSTEMI. All have been acute events. First in 2006 in LAD. 2 stents. Second in 2015. NSTEMI in LAD between the 2 stents, third overlapping instent stent. Third event in 2022 in RCA, STEMI. 1 stent fitted. So four stents in two pipes from 3 events. I've had 5 angiograms. Three during the ACS events, and two following the recent two events. The progression of my disease in those angiograms is virtually static. That is, there was no obvious narrowing in any of the four main pipes, only distal deposits. In my case, everything looks great and generally always has for the past 18 years. I've never had angina from exertion. Contine to climb, hillwalk, etc... Some folk never get a nice predictable pattern of heart disease. My cardiologist can't rule out another acute event, but tells me he expects me to make old bones, and I'm not in the least chance of getting a bypass surgery because in his words there is nothing to bypass. We are all different. Life is a game of Russian roulette. Meds, diet and exercise help take bullets out of the chamber, but they don't empty them all. Enjoy everyday like it's your last.
"We are all different. Life is a game of Russian roulette. Meds, diet and exercise help take bullets out of the chamber, but they don't empty them all. Enjoy everyday like it's your last."
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