Heart Attack ?

[Wheels-Of-Fire]

The graphics have moved on a bit. The procedure I had last week was displayed on a 60 inch UHD OLED screen. The video is mostly taken at 12 FPS but they switch up to 22 FPS for recordings, you can hear the ticking as frames are shot.

Another improvement is with chest x rays. You no longer have to wait for a porter to wheel you to the machine, it comes to you. Looks like a large sit on mower but then the top unfolds like a cartoon transformer and it becomes a remote controlled x ray machine. Stand well clear everybody please !

[Mark Turner]

Graham I hope everything goes right for you its a bit of a sh1t situation but welcome to the club it seems us forumites seem to have good or bad ailments . We all seem to have bad ailments but keep on going.That can only be a good thing as we are all soldiering through

[Bob Williams]

Wheels-Of-Fire wrote:

The graphics have moved on a bit. The procedure I had last week was displayed on a 60 inch UHD OLED screen. The video is mostly taken at 12 FPS but they switch up to 22 FPS for recordings, you can hear the ticking as frames are shot. Another improvement is with chest x rays. You no longer have to wait for a porter to wheel you to the machine, it comes to you. Looks like a large sit on mower but then the top unfolds like a cartoon transformer and it becomes a remote controlled x ray machine. Stand well clear everybody please !

…And that is what happens when one of us Geeky Forumites goes into hospital! WoF Checking out the medical tech while being exposed to it.

When the Thought Police arrive at your door, think -
I'm out.

[Ed P]

Most of the techies like having an appreciative audience as many feel that they are not treated as equals by the House Doctors despite having generally better degrees and more training.

I recollect one technician nearly throwing a wobbly as she just could not get it through the thick heads of the Hospital Management that a Brexit contingency plan was required for the radioactive Technetium used in Myocardial Perfusion tests.

This element only has a half life of 6 hours, and is only produced in Holland, if the stuff goes 16 hours from leaving the reactor in Holland without being used it has to be thrown away. She said that even on a good day sometimes ferry delays resulted in unusable material.

She said that she had had a horrible morning banging her head against a brick wall as she could see Hospital Management eyes glazing over as soon as she said radioactive half life. I think she liked having someone able to say ooh and aah in the correct places, and seemed to finish her session with me a lot happier than when she started.

[The VFM Addict]

Dave Rice wrote:

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.

_______________________________________________________________________________________

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.

[Wheels-Of-Fire]

I did indeed have a small magnesium deficiency and they have put me on a supplement for that amongst other things.

Had the promised second angiogram today but im not much the wiser. The results are to be discussed at the big weekly cardiology meeting tomorrow so I should know more by the evening.

In the meantime cardiology want me to have an endoscopy to make sure that I no longer have any internal bleeding, they want the option of giving me stronger blood thinning drugs, but the gastric people want a guarantee that I won’t die on their table first 🙄   Last I heard they were still arguing about it.

[The VFM Addict]

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?

_______________________________________________________________________________________

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.

[Wheels-Of-Fire]

My pulse rate was about 150 at rest when they did my first angiogram and it stayed there but during the 2 hours they spent trying to fit a stent my blood pressure droped, they said it was because my heart just wasnt contracting hard enough. I only came off preasure boosting drugs 3 days ago and my blood preasure is still only just up to safe levels.

I don’t know what artery they were working on because I just trusted them but, you know, im beginning to have my doubts.

[Wheels-Of-Fire]

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.

[Dave Rice]

I had retching hard enough to damage my abdominal wall but never actually threw up. That’s when I knew it really wasn’t indigestion and got the Mrs to phone the doctor who said dial 999. Within 5 minutes the motorbike paramedic was there followed fairly soon by the ambulance. I worked out quite quickly what they thought the problem was but have to say I was never concerned or in fear of my life. Having been through a life changing accident at the age of 22 I knew I just had to trust them and they would do the right thing. Worrying wasn’t going to help.

The Mrs was I think in denial until we got to the Bristol Heart Institute rather than the BRI where they grabbed her and sent us different ways. Six aspirins and under an hour later the stent was in, but I gather from the comments being made it was a bit tricky. The part of my heart that was damaged deals with back pressure to the lungs (probably got the description wrong) so I have issues with fluid on the lungs. I have double the normal dose of diuretics but any cold that goes to my chest (like now) is a total PITA. I can also pee for England.

For the stress testing you normally pedal a machine but as I can’t do that they had to inject me with something to raise my heat activity which I didn’t like at all. The most boring test was being strapped into a machine for an hour whilst it did a 3D scan of the heart, but at least we now know exactly what the damage is and so it can be dealt with.

Every time I get my bloods & pressure tested they are perfect. As long as I can move at my own pace, which is only a bit slower, I can walk for long periods. But any quickening of the pace or stairs / steep slopes and I’m done within 10 minutes, but they’ve always been a problem mechanically with a leg that doesn’t bend.

The Mrs chucked the deep fat fryer away but I can’t say my diet has changed radically as we were moving in a more healthy direction as a family anyway. We have a formal veggie day once a week but quite often we’ll go through a meat free day without planning to. I got a vegetarian cookbook for Christmas with some good ideas in it, but I can honestly say we’ve not had a boring veggie meal yet and I’ve never been near a nut roast.

Stopping smoking and drinking moderately were the biggest changes and probably what caused the problem in the first place. I think bread may have to go though and that will be a wrench.

[Ed P]

There are now quite a lot of vegetable protein ‘mock meats’ and cheeses available in the UK.

The vegetable minces make darned good curries and chilli con carne.

I was introduced to them 30 odd years ago in the Far East. The Bhuddist  religion forbids deliberately killing animals for food, so they have had years of practice in emulating fish, pork, beef etc. As I recollect these were a lot more tasty than the stuff you can now get in the UK, but it was probably laden with MSG and salt which have since been banned by the Western  health Gestapo.

[The VFM Addict]

Wheels-Of-Fire wrote:

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.

_______________________________________________________________________________________

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.

[Wheels-Of-Fire]

Hmm, sore point getting any info out of a medic around here.

Even with my bestest, non threatening, you know best oh mighty one attitude, any request for a explanation is treated as an insult to their medical judgement.

 

[Ed P]

This may be a bad time to get info as quite possibly the Grand Poobahs are taking a break, and the lesser Mandarins are afraid of saying anything that will come back to make them look foolish or bite them in the bum.

[The VFM Addict]

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.

_______________________________________________________________________________________

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.

[Wheels-Of-Fire]

I am in Northwick Park Hospital, one of the largest teaching hospitals in the country and a university trust. Also famous for some of the biggest cockups in recent medical history.

[The VFM Addict]

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.

_______________________________________________________________________________________

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.

[The VFM Addict]

As an aside I always think Nicolas Parsons when I think of N.Park.    Do you recall the large graffiti that was on the roundabout to the north west of the hospital for years – It read “Nicolas Parsons is the Neo-Opiate of the people”.   That was back in Sale of the Century days and I knew a Consultant who told me he was certain he knew the two medical students that did it.

_______________________________________________________________________________________

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.

[Ed P]

“Also famous for some of the biggest cockups in recent medical history.”

Giving their situation, I can fully understand why you are getting little feedback. You have a Good News/Bad News situation.

The Good News is that everyone will be under pressure to perform. I bet they are cleaning under your bed every three hours, and everything gets at least double checked.

The Bad News is that you will only get info from the Grand Poobah, everyone else will be scared to rock any boats. They will also be ultra cautious in your treatment which is in itself a good news/bad news topic as caution translates to extended time as well as a better result. I’m afraid it looks like you may have to be a patient patient for a while.

As others have said it is a sh1te situation, but we are all cheering you on, and wishing you all the best.

[Bob Williams]

Rock on Graham, get bloody-minded with them! Better news THIS year I hope.

When the Thought Police arrive at your door, think -
I'm out.

[Author]

Posts