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Heart Disease (Expert Forum)
stents?
Answered by
Cleveland - OH
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stents?
by Sweetwaterguy, Nov 12, 2008 12:13PM
I am a 65 year old male, 6'5" and 208 lbs. CT suggests 40-70% blockages in two arteries and the cardiologist indicated I might be short of breath. Two years ago I had a successful ablation for a fib.
Yet I live an active lifestyle. I golf and walk a hilly course four times a week with no problem and can hike 10 miles at high elevation to a favorite Wyoming mountain lake a couple of times a summer. I do get short of breath sometimes during sexual activity and when I put my heart under a load like lifting 50 pounds and carrying it a short distance.
I take 40 mg lipitor and have my cholesterol down to 125, even though my ratio remains poor.
I would like to be more aerobically fit and think these blockages are preventing that.
Are the risks of stents too great to consider? Is it reasonable to believe my statin regimen and active lifestyle might allow me to at least maintain my my cardiovascular health? Do stented arteries develop blockages at the same rate as nonstented arteries?
Yet I live an active lifestyle. I golf and walk a hilly course four times a week with no problem and can hike 10 miles at high elevation to a favorite Wyoming mountain lake a couple of times a summer. I do get short of breath sometimes during sexual activity and when I put my heart under a load like lifting 50 pounds and carrying it a short distance.
I take 40 mg lipitor and have my cholesterol down to 125, even though my ratio remains poor.
I would like to be more aerobically fit and think these blockages are preventing that.
Are the risks of stents too great to consider? Is it reasonable to believe my statin regimen and active lifestyle might allow me to at least maintain my my cardiovascular health? Do stented arteries develop blockages at the same rate as nonstented arteries?
Doctor's Answer
by Cleveland Clinic, Nov 12, 2008 07:21PM
, Nov 12, 2008 07:21PM
I am not sure what your shortness of breath is from, but it is a very rare presentation for severe coronary artery disease. Also, the CT scan is a sensitive test but it is poorly specific, meaning, when negative, its predictive value is high, however, when positive, as in your case, because of various artifacts including the presence of calcium in some pt's coronary arteries, its positive predictive value is not so good. A stress test such an exercise echo or exercise nuclear study would be very helpful. If you develop symptoms during the test and there are findings consistent with ischemia, especially in the territories covered by those two arteries, that would be more convincing. In the end, medical management of this type of disease is as good as stenting in terms of mortality benefit. This can't be said about symptomatic improvement. Stents are much better in improving symptoms. If you do need a stent, the risks of stenting are not high at all, and if your symptoms do improve, the benefits will certainly outweigh the risks. Statins have been shown to at most decrease progression and maybe even halt the atherosclerotic process, they certainly don't reverse it. Stenting usually prevents restenosis in the treated areas, they have no effect on the unstented areas at all. The risk of stent closure is in the order of 5%. Once a year has passed, the stents usually don't close/restenose.
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