Taking Control of Heart Disease
Heart disease covers several conditions which affect the heart. This includes ischemic heart disease, heart failure, heart arrhythmias, heart valve issues – this list is not exhaustive. Causes of heart disease often include a history of high blood pressure, smoking, high levels of bad cholesterol, low levels of good cholesterol, a sedentary lifestyle, drug abuse, genetics, and other diseases. For my wife’s father, a virus attacked his heart leading to heart failure and eventually death. The list of causes in developing heart disease are long. Knowing the warning signs can be the difference between life and death, affect the quality of your life and impact family members as well. From the CDC:
Heart disease and stroke are the most common cardiovascular diseases. They are the first and third leading causes of death for both men and women in the United States, accounting for more than 35% of all deaths. More than 870,000 Americans die of heart disease and stroke every year, which is about 2,400 people dying every day. Although these largely preventable conditions are more common among older adults, more than 148,000 (17%) of Americans who died of cardiovascular diseases in 2004 were younger than age 65 years. Heart disease and stroke also are among the leading causes of disability in the U.S. workforce. Nearly one million people are disabled from strokes alone.
The burden of heart disease and stroke should not only be measured by death and disability. More than 80 million (1 in 3) Americans currently live with one or more types of cardiovascular disease. This figure includes 73 million people with high blood pressure, 5.8 million who have suffered a stroke, 5.3 million with heart failure, 8.1 million who have had a heart attack, and 9.1 million who suffer from regular chest pain (angina pectoris). This year alone, more than 920,000 people will have a heart attack (myocardial infarction) and an additional 780,000 will have a stroke. In total, more than 6 million hospitalizations occur each year because of cardiovascular diseases. Americans also make more than 81 million doctor visits every year because of cardiovascular diseases. The cost of heart disease and stroke in the United States is projected to be more than $448 billion in 2008, including health care expenditures and lost productivity from death and disability. As the population ages, the economic impact of cardiovascular diseases on our nation’s health care system will become even greater.
While often preventable, this is not always the case. However, in my case and in many others I held enough knowledge about heart disease and mitigating the risks. Being aware of high levels of total cholesterol and triglycerides for years, I could have controlled the timing of when the disease manifested itself by following a strict diet, taking my medications, and exercising. Failing to do so resulted in my dealing with this disease at a much younger age.
So what does one do when diagnosed with heart disease? Well, it depends on the disease. I will be talking about my own case, but the methods I used to get a handle on my disease are applicable to all diseases. Research is key, knowledge is power, and we do live in a digital age.
So start with Google. Type in your condition in the Google search box and go from there. In my case, I came across interesting sites that you can see in the sidebar of the Heart Disease Blog under the links section. Included is a link to angioplasty.org for my fellow stent owners. Another link is to a forum where you can ask the experts in cardiovascular disease from the Cleveland Clinic, the number one hospital in the United States for heart disease treatment, and others. Check them out if you like.
In the blog section of this site, I try to keep heart patients abreast of the latest developments, current treatments, and future trends in heart disease. I recommend reading Best Hospitals: Heart and Heart Surgery.
Researching you doctor is also important. There are sites that perform this task, but they require a payment, sometimes as high as $50.00. Of course, in an emergency, the patient does not have the time to do this. If you are at risk for heart disease, it is advisable to find the best hospital in your particular location. Also, I would recommend looking for the best cardiologist through research services, asking your primary care doctor, or talking with someone you know who suffers from the heart disease you are at risk for. It could mean the difference between life and death.
Don’t be afraid to ask questions. It is even wise to go through scenarios with your cardiologist. If this happens, what can I expect? Let me give you an example.
In my case, my first visit to my cardiologist happened during a heart attack. Thankfully, a collateral vessel grew to attach to my left anterior descending artery (LAD) at the apex of my heart (the tip), because most of my LAD was 100% blocked. As my cardiologist specialized in stents and percutaneous coronary intervention, the route taken to treat me was with five Cypher drug-eluting stents.
After I recovered, every three months I would undergo a nuclear stress test to check the progression of my disease and whether any of the stents were closing up. It would be a year later when I first failed the stress test. During the intervention, one cardiologist discovered an aneurysm at the tip of my LAD where it came off the left-main artery and in-stent restenosis with new plaque near the apex. When my cardiologist came into the room he asked me a question: Do you want stents or a bypass?
Under heavy medication – including morphine – my clouded mind thought the question a jest. I mumbled stents, smiled, and drifted in and out of consciousness. Later came the news – my LAD was jacketed stem to stern – a full-metal jacket in the jargon of the cardiologist. No bypass for me – ever – unless willing to undergo a riskier procedure where the stent is removed or partially cut away.
Should my cardiologist taken the time to explain to me during our meeting a couple of days before the intervention what the possibilities were? Certainly. However, having saved my life the first time to the point of complete recovery, my anger was transient. He is human. What if I had taken the time the learn enough about my disease to ask the relevant questions? A quick look at some of the sites from a Google search alerted me to the possibility of a full-metal jacket. The decision would empower me at the same time to take an active role in my care. I could ask my cardiologist his belief in the best approach, maybe searched for a second opinion, done more research on the subject. As my disease is diffuse in three arteries, recent research suggests that bypass is a better alternative to stents for patients with diffuse multivessel disease. However, how many people my age were included in that study?
Remember that doctors in the United States are driven hard from the moment they enter medical school, through their entire residency, and finally in their practice. They are not perfect and the culture of hard work and study ethic stamped into their minds from the moment they enter the field of medicine make them vulnerable to overlooking something involved in your current and future care. That is why educating yourself on your condition is so critical to your success. So remember, doctors are human and, even if talented, they can make mistakes.
Some information you should know if you are considering getting a drug-eluting stent:
The possibility exists you will be on Plavix for life. This can create issues if an operation is in your future, and who can predict that? There are protocols for stopping Plavix, but the risk of a heart attack or other cardiovascular event increases.
When drug-eluting stents first entered the scene, they generated much excitement. Coated with an immunosuppresent, conventional wisdom led many to believe that in-stent restenosis due to excessive scar tissue would drop. With bare metal stents, this rate of restenosis is around 30%. With drug-eluting stents, this decreased to 2%-5%, depending on the study. However, it soon became clear that another surprise lay in waiting. The possibility of late stage thrombosis – an often deadly event. While the incidence rate is low, in an attempt to mitigate the possibility of this event in a patient, most cardiologists will keep their patients on dual anti-platelet therapy for life (Plavix and Aspirin).
Make sure you tolerate Plavix well. Should a mild allergic reaction occur, it will often resolve itself with a drug such as Zyrtec (this is what I did).
Make sure you get a TEG test done after being on Plavix for 1 month. This is a new test which indicates the amount of platelet inhibition. My first test suggested only 20% inhibition prompting my cardiologist to increase my dose from 75mg/day to 150mg/day. Subsequent tests showed 80% inhibition rates. It is telling that since increasing my Plavix I have passed two stress tests after failing the previous five (update: the number is now three stress tests).
On label use of drug-eluting stents (DES) is for short lesion blockages in a single artery. Anything else is off-label. This does not preclude the use of these stents for multiple blockages, long lesions, or stenting within a stent. Just make sure your cardiologist doing the intervention is one of the best before taking this route. That is what I did.