@thevfmaddict
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Forgot you lived in Harrow or I would have guessed that. As your heart attack showed on the ECG it must have been a STEMI (ST wave Elevated Myocardial Infarction). I’m pretty sure the protocol in your area is for Ambulance crews to take patients exhibiting a STEMI’s trace straight to Harefield Hospital. So if the Ambulance crew ran an ECG then its only the bleed that would have changed that. Anyway, if the Gastro Team can resolve the bleed risk there’s a very good chance you’ll be transferred to Harefield and you definitely will be if you need a bypass. So don’t worry about bad cardiac knife work at Northwick Park if you need it; unless as a sudden emergency. If you’ve never been in a specialist hospital before then they are always a million miles from a general madhouse like Northwick Park. Medics are not as offish because they don’t have to deal with drunks and druggies off the street, etc., as medics do in a general hospital, teaching or not. Think Dorcester versus poorly run B&B when it comes to how staff treat patients is a specialist hospital.
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Good point, Ed. Probs best to wait until the Consultants are back.
Not sure, Graham, if your hospital is a Teaching Hospital? If so then asking questions at the Team Round (which is always a good time) is even better. Most Consultants welcome the chance to ‘teach’ both you and their teams at that point; and of course in a Teaching Hospital answering questions without hesitation truly is second nature.
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And there was a lot of blood. I had already been as sick as I thought I could be before the bleeding but then I filled 3 more small bowls with blood. About 1.5L as an estimate.
That was a major bleed. Did you ever have a peptic ulcer that you knew about because its close to certain that you had one for such a bleed to occur; and that it was adjacent to a significant blood vessel. And as your BP is still marginal I can understand why the Gastro Team are nervous. All in all it certainly makes management of your status complex. In simple terms you heart needs blood thinning to prevent blood clots but blood thinning means small stomach bleeds won’t clot so can become serious stomach bleeds. The chances are you will be put on a PPI so make sure the Mg is continued and monitored because PPI’s deplete Mg often quite substantially.
The bottom line, as might already be clear is that managing your coronary arteries with stents and drugs is going to be difficult. Triple bypass surgery may be the better option but yet again thinning will be required post that; and anyway they won’t elect for triple bypass until they are confident your cardiac status is (haemodynamically) sufficiently stable to withstand surgery.
In all directions it really is all down to what the Gastro team find when they do the endoscopy. Sometimes it is possible to resolve a single bleed point by sealing that point by electrocauterisation during an endoscopy. It just depends on size and location of the damaged the vessel.
Your high pulse rate during the first angiogram makes sense now given what you said about low BP. BP results from three factors = Heart Rate, Stroke Volume (i.e. output each heart contraction) and Peripheral Resistance (i.e. the tone of your general body vasculature). If your Stroke Volume drops you body compensates by increasing the number of contractions (i.e. Heart Rate). This is only partially effective because as Heart Rate increases the heart’s filling time between each contraction reduces which also to some degree decreases Stroke Volume.
I’m as baffled as was your cardiologist by your echocardiogram findings. Given your BP I would have expected it to nail down the precise problem. But from what you are saying it did not and there were no signs of ventricle dilation or valve issues which would be consistent with low Stroke Volume. But if you were given a positive inotrope to increase cardiac contractility sure as hell your Stoke Volume was low.
Anyway, matey, I hope the above helps in informing your discussions with your medics. I’m a great believer in patients being very proactive in discussions with medics. Because having to explain things to patients in-depth to the patient makes the medics themselves think the matter through afresh which is never a bad thing.
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Being sick soon having a heart attack is not uncommon and is a mild marker that one is probably looking at a heart attack (i.e. Myocardial Infarction) rather than mere angina. Persistent reaching over period of itself can cause minor bleeds. I take it that there was a substantial amount of blood when you were sick rather than mere spotting? Which would suggest that the ibuprofen was implicated. But if there has been no blood since despite anticoagulants being used in ITU, I’m not sure the bleed was anything other than mechanical. However, an endoscopy is certainly needed to decide the issue either way before putting you on DAPT long term.
I’m also curios about your heart rate or blood pressure (?) dropping during the first angiogram such that they feared you might arrest. That is quite unusual. More likely they over did the calcium antagonist doses a bit when doing the angiogram.
Do have you any idea which coronary arteries needed stenting?
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I have a stent, fitted within 2 hours of the symptoms, it’s a doddle. They push it up on a wire via your wrist, mine got stuck at my shoulder so they went in via the groin. You don’t feel a thing until the stent does it’s stuff which can be disconcerting at first, like the blood returning to a dead leg. They’ll put you on the big 4 – aspirin (blood thinning), bisoprolol (blood pressure), ramipril (ACE inhibitor) and a statin (cholesterol). For 12 months there will be a pill that helps the stent and a nitroglycerin spray for under the tongue if you get any bad chest pain (then dial 999). After care is marvelous, but be prepared to have to explicitly tell people that when you say you have a bad chest because of a cold or flu, it’s not that pain in the chest. You now know what that feels like and you will know it again. So good luck, I hope it goes well but it’s not so much bad news as it was years ago. It will be life changing but in a good way as you chuck out the bad habits. If you are a smoker this is your time to pack it in.
The drug that “helps the stent” is Ticagrelor. It prevents platelet aggregation (blood clots). Along with Aspirin it forms the standard DAPT – Dual Anti-Platelet Therapy. The logic is that blood clots can occur at the stent site. Initially Tigagrelor had a licence for 12 month use post stenting by which time it was believed that the stent would have fully “bedded in”. But recent studies have shown benefits up to at least 3 years. It may well be that the general anti-platelet action is the reason for this rather that just at the stent site(s). Most cardiac units are moving slowly over to 3 year use. However, I strongly suspect that although not yet proven, benefits remain from using it even longer than that period. I’m very active in my other half’s care having spent so many years discussing cardiology with medics during my days in pharmaceuticals so discussions re her care can be quite in depth. A while back I convinced Harefield Hospital to keep my other half on Ticagrelor indefinitely after her stents in 2014 because she has consistently elevated platelet counts. She’s now been on it for well over 5 years. No adverse bleeds so no problem continuing it off-licence. I just had to make a case for the cost and that wasn’t too difficult.
As regards routine post medications – A statin will be standard. But a beta blocker (e.g. bisoprolol) and an ACE inhibitor are not universal. It all depends on your blood profile, ECG & echocardiogram findings, resting heart rate and co-existing conditions. A GTN spray will be routine and often a slow release mononitrate tablet (e.g. Imdur or Isotard).
I keep banging on about it around here but resolving any underlying Magnesium deficiency is probably of huge benefit. So please, please ask your medics to test your serum Mg+ My other half’s cardiac vasculature is greatly compromised. I’ve seen the angiogram recording. She had 4 stents in 2014 and a fifth which was ideally required proved impossible to site. The team expected her to be back within 6 months for a triple bypass. They only went for stents first off due to her numerous other conditions but felt that eventually it would be unavoidable. That was well over 5 years ago. No further adverse cardio event in that time and no increase in bouts of angina. I put that all down to the continued use of Ticagrelor and to robust Magnesium Supplementation (Neomag) which has been prescribed throughout. Unsurprisingly her blood sugars (she’s diabetic) and cholesterol (despite being on high dose statin) also improved once the Mg was started – Mg deficiency worsens all of them.
As for the Nil by Mouth they tend not to worry about that when undertaking Primary Angioplasty very soon after a heart attack. But when its later Elective Angioplasty its a bit belt and braces just in case a need arises to do a bypass there and then – which in reality is quite rare.
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Atheism is one of the reasons I don’t celebrate. Another is that until I stopped, you could guarantee a life changing personal disaster happening at Christmas, so I removed the source and the personal disasters stopped.
Sounds like you’re celebrating not celebrating…….LOL…….🎅
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
Alan Johnson, an ex Tesco Shop worker, Postman, Union leader and IMHO the best Leader Labour never had, has already slammed Momentum saying he wants it gone. He was a true moderate and the only Union member of the Labour’s NEC who voted to abolish Clause IV.
If he wasn’t of the opinion that he is too old for the task and hadn’t already quit Parliament I truly believe he would be the ideal figurehead to lead a fight back against Momentum. He had an amazing ability to appeal to all from shop floor to boardroom and sadly never reached his full potential while in Parliament; too often he was shuffled and used by those in charge as the go to man whenever a safe pair of hands were needed.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
They are top notch – SEE
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
Could be anything causing it – e.g. a bad drive or even a case fan attached to a mobo header.. I’ve seen it all. The best approach is disconnect everything except mobo and ram and see if it starts then. It can’t be the power switch because you are seeing lights. If it starts barebones then add items back one at a time until you find the culprit.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
There were also several Heathrow Mortar attacks in 1994 all of which failed to explode on impact.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
I got it wrong also. I said a tiny Tory majority…………..LOL
Unless BoJo messes up big time in his first term I suspect we are talking two or three Tory terms before the wind changes. It will surely take at least one more defeat, just as it did post M.Foot, before Labour gets too sick of losing and a Blair type centerist gets his/her chance.
Until then Momentum will blame it all on Brexit and Corbyn rather than the extreme leftist policies that were on being offered (i.e. nationalise anything large that moved and tax big businesses out of existence). Just listen to John McDonnell at the moment, a clearer case of someone in denial it is hard to find.
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Well, its that day. The Polls say it will be a lottery and is entirely unpredictable. So just for fun lets treat it as such. Pick a number or tight range.
Me bet is a tiny Conservative majority of 8 to 12.
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Don’t worry. If Corbyn gets in he’s going to sort out the railways. 😂
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I would have thought the exact reverse, Ed. Bad weather affects all voters alike and the records show that during inclement weather it tends to be Labour voters rather than Tory voters that stay at home.
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November 21, 2019 at 4:55 pm in reply to: Could the Lord and the Count be King Makers in Uxbridge? #38438@Dave
In the 1980’s I lived less that 150 yards from the front entrance to Brunel. I used the shops on campus and the bank. My first wife worked for the Uni. Brunel receives an above average percentage of its income from research, services and consultancy for businesses. It is very commercially orientated. I cannot perceive that will have changed much. It could well be that the Labour manifesto will be at least to some extent modify the attitudes of lecturers. Because the Labour plan will decimate business and inward investment into the UK. Have you seen this and this.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
November 21, 2019 at 2:37 pm in reply to: Could the Lord and the Count be King Makers in Uxbridge? #38428I agree there is very much a serious side to rag week these days but the piss-up insanity though less than it once was is still there as well. I see it in the local town centre and local pubs every year.
I certainly wasn’t dismissing them. Quite to opposite. Rather I was saying that the small number that might be inclined to register a protest via the Lord or Count could be critical in a seat where the prospect of recounts is not that remote this time around.
However, Brunel is very much a business orientated uni. Anyone who has read the fresh off the press Labour manifesto will see instantly that it will crush UK businesses and inward investment. The IFS are already describing it as proposing the most punitive Corporate Tax system in the world. Talk about ramp up government debt as well. It proposes re-nationalisation of water, energy, rail and the Royal Mail plus of course part BT re-nationalisation to provide free broadband. Everything else gets pretty much taxed out of existence. Even the leftist BBC is starting to slag it off. I respect students enough to know that even they will see this as a far worse “coming their way” offering than anything the Tories are proposing. Moreover, the Labour plan would make it totally impossible to broker any kind of deal with the EU so you can forget that too if Labour gets in.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
I found the first article very interesting in that it linked a magnesium deficiency to increased skin fatty acids, and I guess the ‘old person smell’. Perhaps a self test for incipient problems is that collars and cuffs get dirty more quickly! “Intracellular magnesium deficiency may also cause an increase in intracellular sodium and calcium, which predisposes to arterial vasospasm, increased catecholamine release, increased fatty acids and lipids, as well as intravascular hypercoagulability.”
Pretty much coronary vasospasm only ever occurs when there is an excess on intracellular calcium ions in the presence of a hypersensitive vasculature. Magnesium is often referred to as nature’s natural calcium antagonist. So it plays a big role in controlling intracellular calcium ions.
Coronary vasospasm is not exercise induced so can occur at rest. Usually it is referred to as unstable angina. Heart attacks that derive in major part from vasospasm are called Non-STEMI. This is because the patient’s ECG trace shows no sign of ST wave elevation which is the norm with most Myocardial Infarctions. If anything one will usually see a mildly depressed ST wave rather than an elevated wave. The depression is often so subtle that ambulance crews miss it and hence pick up more slowly on Non-STEMI’s that normal heart attacks. Such a failure almost cost my other half dearly but as I have considerable experience of discussing ECG traces with senior cardiologists and had seen mildly ST depressed traces on two consecutive days, I put my foot down and they took her in. At hospital they were overheard saying to another crew that I was worrying too much. My other half did not tell me about that until after they had left the unit. Lucky for them or I’d have made them eat the paper her blood results then came on. Her tropinin (a cardiac enzyme marker indicative of an M.I.) was at 2000 and anything above 10 strongly suggests an M.I. In the event an angiogram showed that she needed either an immediate triple bypass or multiple stents.
Generally speaking Non-STEMI’s tend to cause less extensive pain and are more frequently ‘silent’ that STEMI’s. This means they are often mistaken for simply a transient angina attack. Add to this that women more frequently suffer silent M.I’s than do men and one needs to be doubly cautious if there is even the slightest chance that a woman has suffered an M.I. Oh BTW the pain suffered by women is often upper abdominal rather than classic central chest, neck and left arm and this atypical presentation too can incline to the infarct not being immediately suspected.
I am, due to all of such, somewhat uncomfortable with our local protocol which is that ambulance crews only take STEMI’s direct to Harefield Hospital and all other suspected M.I’s go first to our local general. The risk, especially in the winter, is that Non-STEMI patients sit for some time in the log jam of ambulance trolleys at the local general before they have their bloods taken and their M.I. is confirmed. My other half benefits from me knowing my stuff and being confident enough to state a case immediately and compellingly to medics. But most folks though have to trust in the ambulance crews and in my experience many are inadequately trained in recognising when one is looking almost certainly looking at a Non-STEMI’s. Rant over.
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Oh, I forgot to add that if you are either Diabetic or take a PPI or Diuretics; or drink a lot of fizzy drinks or suffer IBS, then it is more likely than not that you will be Mg+ deficient.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
Dave,
Has your serum magnesium been checked when your bloods were done?
Few doctors, GP’s or Consultants, are up to speed on the growing body of evidence of its importance in CHD. Mg+ deficiency is devastating in the long term for cardiac health. Also if you do suffer another heart attack you are far more likely to survive if your levels are good because such allows cardiac cells to survive longer periods of ischemia.
The following two articles from the BMJ’s online OpenHeart journal are well worth a read.
https://openheart.bmj.com/content/openhrt/5/2/e000775.full.pdf
https://openheart.bmj.com/content/openhrt/5/1/e000668.full.pdf
If you haven’t had your serum magnesium levels checked make sure they are next time your bloods are done.
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During the Covid-19 Epidemic I will be wearing a mask and goggles while posting so that if I become infected I won't spread it to you.
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