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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Are Chances Of Repeat Heart Attacks After An Angioplasty?

Hi, I m brand new to this. Last night, my 40 yr old husband had a massive heart attack in his LAD. 99% blocked with a clot, heart stopped, one shock brought him back. He was transferred to a cardiac hospital where they did an angio, busted the clot then inserted a stent. The doctor said that his RCA (?) actually showed an old blockage of 100%, but that his heart compensated and created new blood paths. His CX (?) is 50% blocked and his RI is also 50% blocked. His ejection fraction last night was 20% and the doctor said his heart is in bad shape. I m getting these terms (RCA, CX, RI) from a diagram that the doc gave to us. He had some extra fluid on his lungs last night, given lasix but its working slowly. Earlier tonight he spiked a temp of 101.something and his O2 sats went down. They took a chest x-ray and have diagnosed him with pneumonia also. I don t really know the Dr. who took care of him (he was transferred to this hospital from a smaller one) and I m not quite sure how much normalcy my husband can expect. Its been approximately 24 hours since his heart stopped and he was brought back. Should I still be worried about another imminent heart attack or sudden death?
Mon, 31 Aug 2015
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Cardiologist 's  Response
Hello. Welcome to HCM and thank you for your question. I understand your concern.

First, I am sorry about your husband's condition. Due to myocardial infarction, a part of the cardiac muscle undergoes necrosis ("dies"). This "death" augment a complex process in the organism, to compensate for the situation. There is an estimated risk of death and major cardiovascular events in the first 11 days after every myocardial infarction. Of course, these risks vary in probabilities, according to the artery that has caused the attack, but every scenario is possible. Stenting and opening a blocked artery, causative of the heart attack, within 6 hours after the onset of the pain, is accompanied with good outcomes and the heart can benefit a great deal, in terms of regaining the function, but this can be assessed only 3-6 months after the attack, after the myocardium (heart muscle) is "un-stunned". At this moment, the main worries and preoccupation is about his basic health and vital signs, since this is a critical moment. As about the other arteries, we usually deal with them at least two weeks after the infarction. In the first moment of arrival, we only deal with the culprit artery. The doctor has tried to explain to you that the right coronary artery (RCA) was totally closed, but chronically, not acutely. Therefore, it did not cause infarction, because, due to the nature of chronic and slow closure, some little vessels (called inter-coronary collaterals) were opened to support the zone of RCA with oxygen and nutrients. These arteries probably are supplied with blood from left circumflex (LCx) artery and ramus intermedius (RI) artery. Hopefully, the stent procedure and the life support went well, and this critical moment has passed.

I hope I was helpful with my answer. Take care. Good luck.

Dr. Meriton
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What Are Chances Of Repeat Heart Attacks After An Angioplasty?

Hello. Welcome to HCM and thank you for your question. I understand your concern. First, I am sorry about your husband s condition. Due to myocardial infarction, a part of the cardiac muscle undergoes necrosis ( dies ). This death augment a complex process in the organism, to compensate for the situation. There is an estimated risk of death and major cardiovascular events in the first 11 days after every myocardial infarction. Of course, these risks vary in probabilities, according to the artery that has caused the attack, but every scenario is possible. Stenting and opening a blocked artery, causative of the heart attack, within 6 hours after the onset of the pain, is accompanied with good outcomes and the heart can benefit a great deal, in terms of regaining the function, but this can be assessed only 3-6 months after the attack, after the myocardium (heart muscle) is un-stunned . At this moment, the main worries and preoccupation is about his basic health and vital signs, since this is a critical moment. As about the other arteries, we usually deal with them at least two weeks after the infarction. In the first moment of arrival, we only deal with the culprit artery. The doctor has tried to explain to you that the right coronary artery (RCA) was totally closed, but chronically, not acutely. Therefore, it did not cause infarction, because, due to the nature of chronic and slow closure, some little vessels (called inter-coronary collaterals) were opened to support the zone of RCA with oxygen and nutrients. These arteries probably are supplied with blood from left circumflex (LCx) artery and ramus intermedius (RI) artery. Hopefully, the stent procedure and the life support went well, and this critical moment has passed. I hope I was helpful with my answer. Take care. Good luck. Dr. Meriton