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What Causes Recurrence Of Heart Blockages?
Question: I am a 60 y o woman with premature CAD. I had 3 stents placed in my right artery last year and another 2 weeks ago (new blockage, clear last year). Couldn't tolerate statins last year so am vegan, eat little sugar and have lost 15 lbs. I was already very active and have continued aerobics, ballet, walking.. on my own got my numbers down from chol 311 to 220, HDL 40 to 70, LDL 168 to 138. However, it apparently wasn't good enough to stop the blockage from occurring. I do have strong family history, Father , first heart attack at 48, half sister (Father;s daughter, died of HA at 58, though she smoked and ate badly). I am now seeing a cholesterol specialist who has me taking 100,000 units of Vit B per week so he can start me on Crestor in 3 weeks. My questions are: It seems to me the time period of less than a year was super fast for another blockage of 95% to appear. Is that unusual? Also, I still feel SOB and have some neck symptoms (my original symptoms were all neck, fullness and discomfort at base of neck) most days. I remember that I did have a rough and long recovery last year but thought with just one it wouldn't be so bad. Does anything sound alarming? Thanks XXXX
Brief Answer:
None of medical details alarming.
Detailed Answer:
Hi XXXXXXX
Thanks for asking.
I am Dr. Prakash HM and I will be answering our query.
Based on your query, my opinion is as follows:
1. Atherosclerosis starts at birth and increases progressively. The previous stents were due to severe blockage (90-95%). At that time, this new blockage which developed, would have been around 30-40% has progressed.
2. The progression could be due to
a. Increased lipid levels in last year.
b. Another atheroslcerotic thrombus at another location, which got ruptured, moved forward (emboli) and joined at the present new block. This appears more
probable. Lipid levels would have contributed, however, it alone would not cause so soon usually.
3. It is not unusual. New thrombus can been seen within as short as 3-6 months.
4. The high dose Vit B (Niacin) therapy is known to work on occasions. If you have any pain in liver area or signs of liver failure like jaundice, etc, you need to meet your doctor immediately. If and when you start Statins, check the liver enzyme levels after a month, to see if any damage is occurring.
5. The present lipid readings are excellent and if it is without Vit B, really good. Continue your active life along with diet. Increase fiber and that should be all. Statins, would not be necessary, if you have the present lipid readings.
6. You will recover as good as last year, as nothing much as changed. Go slow for a month.
7. Neck symptoms, if on the upper back and if it has pain, an X-ray would be beneficial. Did you have any thyroid problems? More details necessary regarding symptoms, investigations and medications to advise regarding this.
It is all usual for anybody above 50 years. Not to worry. Nothing alarming in your medical history.
Hope it helps.
Any further queries, happy to help again.
Take care.
Dr. Prakash HM
None of medical details alarming.
Detailed Answer:
Hi XXXXXXX
Thanks for asking.
I am Dr. Prakash HM and I will be answering our query.
Based on your query, my opinion is as follows:
1. Atherosclerosis starts at birth and increases progressively. The previous stents were due to severe blockage (90-95%). At that time, this new blockage which developed, would have been around 30-40% has progressed.
2. The progression could be due to
a. Increased lipid levels in last year.
b. Another atheroslcerotic thrombus at another location, which got ruptured, moved forward (emboli) and joined at the present new block. This appears more
probable. Lipid levels would have contributed, however, it alone would not cause so soon usually.
3. It is not unusual. New thrombus can been seen within as short as 3-6 months.
4. The high dose Vit B (Niacin) therapy is known to work on occasions. If you have any pain in liver area or signs of liver failure like jaundice, etc, you need to meet your doctor immediately. If and when you start Statins, check the liver enzyme levels after a month, to see if any damage is occurring.
5. The present lipid readings are excellent and if it is without Vit B, really good. Continue your active life along with diet. Increase fiber and that should be all. Statins, would not be necessary, if you have the present lipid readings.
6. You will recover as good as last year, as nothing much as changed. Go slow for a month.
7. Neck symptoms, if on the upper back and if it has pain, an X-ray would be beneficial. Did you have any thyroid problems? More details necessary regarding symptoms, investigations and medications to advise regarding this.
It is all usual for anybody above 50 years. Not to worry. Nothing alarming in your medical history.
Hope it helps.
Any further queries, happy to help again.
Take care.
Dr. Prakash HM
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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