One Week to WISE Cath

[KimC]

Hi, everyone.

June 14 is my sixteen-week follow-up cath at SHANDS for the WISE study. (See info below if you're curious about WISE). The adenosine provocation cath will reveal if the study med has improved blood flow in my heart.

My last coronary flow reserve was 2.6. (Normal CFR is 3.5-14.0). At that point in time, I was diagnosed with angina decubitus due to cardiac failure.

I'm happy to say that I no longer feel symptomatic unless I really overdo it or eat poorly. I've also adjusted emotionally but wonder if others handle the anxiety better than I do. (Feel free to add your advice. I'm thick-skinned).

Dr. Kerensky also plans to further investigate the myocardial bridge during the cath. The only "cure" for the kink is bypass. Many people with bridges never have to cross that bridge ... (awful joke).

Has anyone had or heard of bypass surgery and aortic valve replacement at the same time? I have no idea if it's even possible, or if they'd want to perform either.

I guess only time will tell.

I'm hoping that the medications will have improved things. I'll give y'all an update after the cath.

Thanks for listening.

Best,

Kim

P.S. Did I mention I'm scared *@%$less to have another adenosine cath?

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Info on WISE study:

OBJECTIVES: The Women's Ischemia Syndrome Evaluation (WISE) is a National Heart, Lung and Blood Institute-sponsored, four-center study designed to: 1) optimize symptom evaluation and diagnostic testing for ischemic heart disease; 2) explore mechanisms for symptoms and myocardial ischemia in the absence of epicardial coronary artery stenoses, and 3) evaluate the influence of reproductive hormones on symptoms and diagnostic test response.

BACKGROUND: Accurate diagnosis of ischemic heart disease in women is a major challenge to physicians, and the role reproductive hormones play in this diagnostic uncertainty is unexplored. Moreover, the significance and pathophysiology of ischemia in the absence of significant epicardial coronary stenoses is unknown.

METHODS: The WISE common core data include demographic and clinical data, symptom and psychosocial variables, coronary angiographic and ventriculographic data, brachial artery reactivity testing, resting/ambulatory electrocardiographic monitoring and a variety of blood determinations. Site-specific complementary methods include physiologic and functional cardiovascular assessments of myocardial perfusion and metabolism, ventriculography, endothelial vascular function and coronary angiography. Women are followed for at least 1 year to assess clinical events and symptom status.

 

[geebee]

Kim,

What is an adenosine provocation cath?

Also, I think it is possible to have by-pass surgery & AVR at the same time. I believe a few members have done so. One of the reasons they do a cardiac cath prior to VR is to make sure all the arteries are clear. I think that is because they want to find out if a by-pass is needed also (although I could be wrong).

Good luck with your tests.

 

[Teresa UK]

Has anyone had or heard of bypass surgery and aortic valve replacement at the same time? I have no idea if it's even possible, or if they'd want to perform either.

Kim, I was interested in this question as well, and a couple of weeks ago I found some guidelines for the management of various cardio problems (which I'm sure was through a link on this site). Here's a bit I saved to a "general info" document I'm keeping:

Nonetheless, because of the impact of untreated CAD on perioperative and long-term postoperative survival, preoperative identification of CAD is of great importance in patients with AR or MS as well as those with AS. Thus ... ... preoperative coronary angiography is recommended in men >35, premenopausal women >35 with coronary risk factors, and postmenopausal women.
Moreover, combined coronary bypass grafting and AVR reduces the rates of perioperative myocardial infarction, operative mortality, and late mortality and morbidity compared with patients with significant CAD who did not undergo revascularization at the time of AVR

I'm sorry, but I can't remember the exact link - although it won't be long 'til someone else can tell you, I'm sure.... Anyway, from this mini-quote it looks as though doing both at the same time may be quite an acceptable option in certain circumstances.

 

[Laurz]

Mitral repair and bypass

Mitral repair and bypass

Kim, while I didn't have AVR I did have my mitral valve repaired and a bypass at the same time. My cardio said that the reason for the cath was two fold. To confirm the regurg of the valve and to check for any other potential concerns. Low and behold an 80+% blockage of the circumflex, so both things were fixed. Hope all goes well for you. Keep us posted. Laurie

 

[KimC]

Thanks for the valuable info!!! I'll have my questions ready for the doc, too.

Gina, the WISE cath protocol is, quote:

"a Doppler-tipped guidewire inserted through a catheter placed in the left main coronary artery to measure coronary artery blood flow and dilation in response to infusions of medications that typically cause blood vessels to widen."

The adenosine infusion stresses the heart. Normal arteries will dilate, increasing blood flow. "Sick" arteries will either stay the same or constrict under pressure. Mine constrict, causing chest pain.

I had my first adenosine cath last February. The chest pain was awful. I remember hearing the bells going off ... my EKG was rapid. And to top it off, I woke-up with the nurse pressing down on my groin after I bled through the cath bandage. I heard her say to another nurse, "She could've died."

I found out later they gave me Heparin, which probably explains the excessive bleeding. (She had to sit on my leg for almost an hour, which is longer than normal post-op).

I need to get my head around this! While I'm happy to be a part of Science, I'm now worrying that the risk is too great. I've been loyal to the WISE study for four months, and can't see jumping ship now.

Best,

 

[KimC]

P.S. Can anyone tell me if it's standard to have Heparin during a cath? It could be related to the protocol I'm undergoing. I don't know.

Curious,

 

[Karlynn]

Kim
As Gina mentioned, we do have members that have had by-pass and valve replacement at the same time. I'm sure it's for the same reason that they never do just 1 bypass. They figure if they're going in for one, they may as well do all of those that look suspicious. So if they're going in to do a valve, they may as well fix the blood supply if needed.

From your description of how you've felt lately, I have high hopes that this next cath will not be as bad an experience. Fingers and toes will be crossed for you.

 

[Nancy]

Joe just had a right and left heart cath. He was on a Heparin drip prior to the procedure. I'm not sure when they stopped the drip, or even IF they did. If he was off it, it wasn't a large window of time. They used glue on him and he had to lie still for 3 hours. No problems with bleeding. They checked his site very frequently.

 

[Yaps]

I had a quad by-pass and mitral valve... but I really cant tell you much ,, it happened very fast and I was out of most of it(major MI) and when I ask my daughter or John.. they just say 'you were dying , they dont remember much...

 

[KimC]

Yaps, I see you were in the F&B business! I worked one summer in a local fish house and haven't been able to eat blackened seafood since. Regarding your surgeries -- you are my inspiration! I can't believe what you've been through! Did I mention you're too young?

Thanks, Nancy and Karlynn!

Love,

 

[Sherry]

Kim, I'm sending some positive thoughts your way next week as you face that cath again. I do remember when you went through the first one and how bad it was for you. You're quite an inspiration to all of us for all you've been through so far, and I really appreciate your updates.

 

[tobagotwo]

To add more confirmation, that is one part of the reason for the cath - if there are any bypasses to do, they want to do them while they have you open. If you search for "leg" in posts, you'll find plenty of valvers who have donated a leg vein to their heart.

I hope this time out that you won't have to endure the chest pain that you went through last time. I hope the vasodilating medicine has helped you.

Best wishes,