Anyone familiar with Coronary Angiography? **Paging Dr. Jon Benson**

[Oneslowz28]

About 2 weeks ago my mother had to be taken from work to the hospital via an ambulance because she was experiencing chest pains. She was given an EKG and other routine test and the Dr in the ER concluded that she was experiencing severe heart burn, but wanted her to follow up with a cardiologist. They set up an appointment with the same one I have been seeing for the last few months. Today was her appointment and I do not know what he did other than a cholesterol test, he did schedule her for an angiography this Friday and has planned to insert stints the same day if any blockages are found.

I have spent the last 2 hours reading all I can on the procedure and I understand how it works and what they are looking for. What I want to know is.. is it normal for the Dr. to place stints the same day as the angiography? My grandmother had to wait 2 weeks before they place hers. I understand that every case is different but am just worried I guess.

[nevermind1534]

They tried to place stints the same day that they found that my father had a clogged artery, but they aborted, because they were afraid of tearing it, because it didn't want to go up, and he had a collateral artery. But they did attempt it right after the catheterization confirmed a blocked artery.

[Oneslowz28]

Just wanted to let everyone know she is out of the Cath lab and they found 0 blockages.

[msmrx57]

Glad to hear good news.

[Trace]

Good news, glad to hear everything is fine.

[jdbnsn]

Hi CJ,

Sorry I missed this post but I have been quite suppressed at work lately and all things life related are not well, sorry for the absence.

As for the standard approach to chest pain; it sounds to me like she recieved an adequate work up based on what you told me. For those who are interested, the typical work does begin with a fast drive to the ER to rule out the most deadly forms of atherosclerotic heart disease. This starts with and EKG and cardiac enzymes drawn from a blood sample. If either of these two tests are positive for evidence of an acute myocardial infarction, they are typically followed by an emergency cardiac catheter aka "angiogram" at which time balloon angioplasty or PTCA (percutaneous transluminal coronary angioplasty) is performed to restore blood flow to the affected portion of the heart. Time is muscle, and the muscle does not regenerate so the faster they are ballooned the better. Stents are typically placed at that time if possible, the idea is that you first use the angiocatheter to inject dye and visualize the vasculature for blockages, while you are in there, it is a very convenient time to balloon any stenotic (narrowed) vessels since you are already right there. So another guidewire is inserted while contrast dye is injected to visualize proper placement, then a very small pill-shaped balloon is inserted into the narrowed vessel lumen, then it is inflated which squeezes open the vessel producing an instant cure to the otherwise potentially fatal condition. A stent is often slipped over the balloon and it is again inflated creating a wire mesh which prevents the vessel from about 60-70% of future collapses.
This series of events happens when a patient fails one of the two first tests, they either have evidence of ischemic heart tissue on an EKG, or presence of troponin-I (an enzyme normally found inside cardiac cells but not normally found in the blood unless cardiac cells have died and lysed), or both. If both of those tests are negative, a patient can safely be discharged from the emergency setting for outpatient evaluation, which is usually carried out with a stress test either classically on a treadmill with an EKG or by injection of cardiolite nuclear isotopes to be photographed later within the heart muscle to evaluate perfusion of the tissue with bloodflow. If all of these tests remain negative the patient is said to be without ACS (acute coronary syndrome) and is diagnosed with angina assuming other diagnoses of non-cardiogenic chest pain have been exhausted.
Hope that helps, and glad to hear she is doing okay!

-Jon

[Oneslowz28]

Thanks for the info Jon. She is scheduled for the nuke stress test in 2 weeks since she has severe asthma and can not do the treadmill.

[jdbnsn]

Strange, that seems a bit out of sequence. Usually the nuke study confirms the need to do a cath/angioplasty. Since she just had the cath, it's a little strange for them to follow witha nuke test knowing that the vessels are patent. But I'm sure there is a good reason for it, and there are other conditions of the coronary vessels that lead to ischemia like prinzmetal's angina, though her age is a bit off for that diagnosis. Anyway, good luck and I'm sure she'll be fine.

[Oneslowz28]

Well she just told me it was a stress test since the angio didnt turn up anything. She is still having chest pains and has days where she gets real tired.

[jdbnsn]

She needs to follow up with her family doc to pursue other possible causes of chest pain. I think a full work up is in order.

[Oneslowz28]

She saw him last Thursday. He prescribed her nitro pills until they figure out whats going on. TBH I think a lot of it is stress related. She is dealing with budget cuts at her job and having to lay off people and cut the hours of some of her most loyal employees. She was telling me that she had to cut this guys hours back to 35 a week and he had not missed a 40 hour week in over 30 years with the company. She is a very compassionate manager and I am sure she takes these problems home with her where it continues to stress her out.

A good thing that has come out of this is that she has cut her smoking by 2/3rds. She use to smoke a pack a day and now is down to 3-4 cigs a day. She is trying to ween her self off of them now.