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Treatment for Ishemic cardiomyopathy - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Heart Failure
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1775 Questions
User :   3 years ago i had a heart scan that showed I had 5 heart blockages, the percents were 90 80 70 70 and 70. I had another one today, and now I have 2 blockages at 40 and 30 percent. My ejection fraction went from 17 to 50 as well. I know that ejection fracture can change over time. How or is this possible for blockages to disappear or decrease this drastically? I do not exercise at all, I have severe neck injuries that prevent me from doing this. My diet has not changed either. I am scared that the doctor has looked at the incorrect report. The doctor that did my first scan was very reputable, but he has since retired. This is a new doctor to the group.
Doctor :   hi
User :   hello
Doctor :   let me read ur query
Doctor :   you have improved a lot
Doctor :   this can happen
Doctor :   and u have had a definite improvement
User :   how does the bockage disappear? Three years ago they wanted to rush me into surgery and I said no. If I had the surgery would have the blockages that were seen ,not have been there? Where do the blockages go? I thought that plaque did not disappear.
Doctor :   with use of medications like clopidogrel, aspirin, and statins, this can go away
Doctor :   i hope ur doctors put you on these medications
User :   the only medication i was taking was coereg and benazepril
Doctor :   that seems odd
Doctor :   may i know ur age ?
User :   the echo report from three years ago stated the left ventricle is mildly dilated in size with mild concentric hypertrophy and with reduced systolic function. the estimated lv ejection fraction is 20-25% There is global hypokinesis
User :   56
Doctor :   ok
Doctor :   so now the EF has improved to 50
Doctor :   the imprvoemnet in EF can be explained
User :   the stress test report said that I had ST changes consistent with ischemia. Yesterday, before he ordered a stat heart scan the EKG stated that I had LVH.
User :   I know the ejection fraction can change. The blockages on the other hand can not be explained. The doctor also told me yesterday I was in complete heart failure...cardiomyopathy. Today, he told me I was fine!
Doctor :   what you had is ishemic cardiomyopathy
Doctor :   this condition improves when the circulation is improved
Doctor :   and hence the cardiac EF will also improve
User :   the stress test from 3 years stated that the ST wave changes I had were consistent with ischemia. Yesterday my EKG showed I was in complete heart failure and/or cardiomyopathy.
User :   but where did the actual blockage go?
Doctor :   they get dissolved
User :   CHF and the blockages are different things. I do understand that my ejection fracture can change. But for someone to have that many blockages (they said 5 major blockages but had reason to believe 8 but three were untreatble) that were that severe how can they dissolve? Why dont doctors tell people to wait it out and they will dissolve? If I had surgery, it would have been unnecessary
Doctor :   'the blockages get dissoolvd with time
Doctor :   usually medications like clopidogrel and aspirain wiht time can dissovle clots
Doctor :   but some docs try aggresive management
Doctor :   it depends on the doctors to trust the medications
Doctor :   some patinets improve with medications
Doctor :   some with procedures
Doctor :   so based on the appearance t your docs advised stent placement
Doctor :   as you had multiple blocks
User :   he said i was not stentable.
User :   The problem is I am still having the same
User :   yes i am
Doctor :   ok
User :   The problem is I am still having the same shortness of breath, heart palpatations, difficulty sleeping(I wake up in the middle of the night gasping for air if I do not sleep on 4 pillows) that I was having 3 years ago. The symptos are still there
Doctor :   your docs took a decision based on the findings available to them
Doctor :   do u have any other issue other than this ?
Doctor :   i mean medical issues ?
User :   Neck problems...I have had neck surgery. I have degenerative disk disease. and high blood pressure that is still extremely high.
Doctor :   eg clotting issues
User :   no clotting issues
Doctor :   i am not sure why ur doctos did not advise you medications like clopidogrel
User :   So plaque in your arteries can dissolve over time. Before the procedure this morning, he said to me ok your condition can not get any better, it can only get worse. We are going in to reassess the situation. And magically...everything was fine. The EKG findings were worse than last time, so he was looking for the report to be worse too. It was just the opposite.
Doctor :   i guess there was some error in the report
Doctor :   or that the vasospasms were presented as blocks
User :   Since the plaque just disappeared, can it reappear the same way?
User :   I just say what you types, I am sorry
Doctor :   its highly unlikely for plaques to appear and disappear that soon
Doctor :   usually it takes years
Doctor :   that is fine
User :   the time between these tests was three years
User :   so can both tests be correct?
Doctor :   yes , in that case , yes
Doctor :   probably u were very lucky
User :   so in three more years they can show back up.
User :   what is a vasospasm
Doctor :   its a contrature in a blood vessel
Doctor :   no the chances of showing up again cannot be predicted,
User :   is that common for a vasospasm to present itself as a block? especially with having such a low ejection fracture?
Doctor :   it depends on the person who is interpreting the angiogram
Doctor :   sometimes mobile clots can cause blocks too
User :   he did say that blockage is in the eye of the beholder
Doctor :   yes
Doctor :   that is right
User :   i did have two strokes inbetween the time of the first heart scan and the second one yesterday.
Doctor :   ok
User :   does that sound like a mobile clot issue?
Doctor :   yes
Doctor :   clots can break from a place of origin and block a region away
Doctor :   and over time they break up and dissolve
Doctor :   this might have been the same
Doctor :   also, medications that were given during the procedure might also have helped in the cause
User :   what precautions, if any should i take for that?
User :   in your opinion...
Doctor :   physical excercise, diet , medications
Doctor :   these are the first part
Doctor :   regular check ups, and regular medications also help
Doctor :   consult ur doc for clopidogrel
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