Heart Attack!

doc henderson · March 21, 2023, 02:24:44 AM

the Holter is an electrical recording for an extended period. not twelve leads like a formal ekg. It is for finding arrhythmia and the computers now count every beat, and give max and min. intervals ect. almost too much information. if you are getting runs of v-tach (potentially fatal) or atrial fibrillation it will record all of that. It will usually let you push a button that says, "i am feeling off and this is why I am getting this study". It may correlate with say V-tach and you need a pacemaker/defibrillator, or it may be blue sky nothing to do with you heart rhythm.
your white matter disease is from years of high blood pressure, diabetes, smoking ect and means none of us are going to live forever, and you may not be able to recall the unusual name given to you 20th grandchild. The damage is to the tiny arterioles at the capillary level on a wholesale basis, and not a plaque or clot in a vessel you could stick a pencil in. think of a vessels that supply the cells, and the red blood cells almost have to line up to get through. It is why we do not live forever.

RetiredTech · March 21, 2023, 08:38:47 AM

@doc henderson
I had a chemical stress test and echo-cardiogram yesterday. Is there any significance to not having a reaction to the medication? I felt a little funny a few seconds after they put it in the iv, but it passed almost immediately. I only ask because my followup isn't until the end of April. They did say they'd call if anything that needed immediate attention was found. The tests were ordered after discovering a right bundle branch block in preparation for foot surgery. The diagnosis was more stressful than the tests. I had always heard horror stories about the chemical stress test.

doc henderson · March 21, 2023, 08:42:31 AM

some people have a bad reaction and we reverse it. that is not related to having a blockage. too much for some. The longer you do not hear from them the better. If they see and area not perfusing, they will move to a heart cath. there is also sometimes a radio-isotope component as well. the are looking for areas of the heart not taking it up (decreased blood flow) before and after exercise.

RetiredTech · March 21, 2023, 08:53:30 AM

@doc henderson
Thanks, That makes me feel better about it.

Nebraska · March 22, 2023, 08:27:41 PM

I sent this picture this morning to Doc H. I thought he might get a kick out if it.

I had that gallery viewing my work as I did a cesarean very early this morning. I felt like one of those surgeons operating in an operating theater, with the crowd above watching me work. Of course you never see the scene where the farmers wife is keeping the viewers from roosting over the top of the surgery with a piece of 1/2 in pvc pipe. She kept the birds from inappropriate perching and took care of the calf once we got her out. While her husband helped me lift the calf out and kept hold of the uterus while I closed the doorway and finished the surgery. Doc suggested I post the picture in his heart attack thread so this is a thread hijack with permission. At last check mom and the baby were doing fine, the surgeon is a bit sleep deprived but not on call for a few days.. Now back to a little cardiology......

doc henderson · March 22, 2023, 09:25:57 PM

NE Woodburner · May 16, 2023, 11:48:56 AM

I lost a friend to a heart attack a few days ago. Service today. He was younger than me at only 55. I had to cancel my last checkup and forgot to reschedule. I just scheduled the appointment for the next available time slot.

Raider Bill · May 16, 2023, 02:21:19 PM

Doc.
I've had several pass from the "widow maker" What is that?

doc henderson · May 16, 2023, 09:13:21 PM

In my opinion it is the fist take off of the Left coronary system before it divides to the left anterior descending artery and the Left circumflex. these do circulation to most of the left side of the heart. Just off the aorta, if you get a clot there, it makes the whole left ventricle stop working from lack of blood supply. It can be a sudden death from an arrhythmia from any heart ischemia in lay terms. Ill see if I can find a video or diagram. the vast majority of heart attacks (blood clot in a tiny artery) make it to the hospital and to heart cath. to live another day.

doctorb · May 16, 2023, 10:49:28 PM

The Cleveland Clinic agrees with doc h.

" A widowmaker heart attack happens when you have a blockage in the biggest artery in your heart. That means blood can't move through your left anterior descending (LAD) artery, which provides 50% of your heart muscle's blood supply. Immediate treatment is crucial for a chance at survival."

doc henderson · May 16, 2023, 10:53:54 PM

that first opening is too short to put a stent and often requires a bypass surgery.

Left anterior descending artery - Wikipedia

I call it at #4, but number 1 is bad as well in terms of the effect on the heart and propensity to have a fatal sudden arrhythmia. this is where the AED comes in.

Automated external defibrillator - Wikipedia

realzed · May 17, 2023, 07:38:16 AM

Interesting.. I had a session in late January last year, where I just didn't feel right / pressure in my chest and sweats, along with some general inability to straighten up when standing..
Asked my wife at 11 PM - to drop me off at the ER as I didn't feel good in general..
When she did I was in there for 12 hours or so with little good info resulting from my visit.
Returned a couple of weeks later for the 'medically induced' test and I knew I failed badly from my own general reaction along with the looks on the staffer's faces during and after.
Still wasn't told much at the time except that I would be contacted and after quite a while that it took me to get feeling stable enough and get my act together, I drove home.
One concerned nurse had me park for a while in the hallway and had me sit in a chair she found, so I could get settled down!
I got a call a few days later announcing an angioplasty app't in '3' months (great health care system we have here in Canada - despite what the government says is 'World Class'- you may think you aren't paying much, but you are in taxes and you do have to wait A LOT..)
Finally - in mid May I hear a Doc say "I have found your problem Mr. D. and I will fix you all up".. but didn't answer any questions at that time while 'on the table' as to what 'my problem' was still..
Finally after a visit later in June, I found out that my Lower Anterior Descending Artery was apparently 95% blocked and that I had a coated stent inserted which apparently patched everything all up!
I also have another blockage about 45% somewhere else that they won't touch until/if it worsens.. lots of pills now (I hate pills!)..
Pretty difficult to get good feedback as you can see - but your info, diagrams, and pictures, have filled me in a lot - so Thanks so much DR. H for your efforts here in the past day or two!!
I have passed a real treadmill test 'sort of' lately = (BP was 220 over 100 something I could tell much even after striving to peek around while walking - which I doubt is good and a couple of past induced med tests since - so I guess I'm good to go for a while yet, but the lack of good (not for lack of asking or trying) info is hard to put up with - as is all of the waiting when you know and your body tells you, that something just isn't right..
Lots of MD's here now present a substantial language barrier and smugness, and there is little to no choice or alternatives - is all I'll say here..
My family GP who got tired of all of the BS and quit his (and my) practice just recently, used the term "widow maker" during my subsequent visit to him, and I sense I was pretty lucky - and that was his assessment and facial expression, as well!
Thanks again..

Raider Bill · May 17, 2023, 08:01:26 AM

It's my understanding that Men rarely survive a widow maker hence the name.
One of my ex's was feeling real bad one weekend. No chest pain she said. Thought it more of stomach gas, sweats. She was in her lower 40's and in great shape.
Finally talked her into letting me take her to the ER.
They triaged her, got excited and whisked her away.
She got a couple stents early the next morning.
Doc told me a man would not have survived what she had and was called the widow maker for a reason. Something about how our systems are built different.
Of course that raised some thoughts on my end..

doc henderson · May 17, 2023, 09:28:06 AM

The term is an old one and more of a lay term. Docs use it because it has been heard of. If the definition is sudden death, then obviously not many survive. you often have warning, and men tend to ignore them. most chest pain is not pain at all, but described as a weight or pressure. If you vomited and or got sweaty, then I really take it seriously. a blockage takes years and is made up from cholesterol plaque in the wall after years of combinations of hypertension, high cholesterol and high insulin and blood sugar. It will be very gradual symptoms and can be managed with medications. An acute heart attack where you are rushed to the cath. lab, is when the plaque that has become hardened by calcium ruptures and the body thinks you are bleeding so it forms a blood clot in the lumen with sudden onset of no blood flow. that is why there can be a difference in how fast they do the cath. and stents. if you have diffuse disease (many blockages) or if there is one at a branch point, then you get a bypass surgery. the left main artery covers over half of the heart, and the side that is required for blood pressure. the right side of the heart just pumps the blood through the lungs. As an analogy, think of a fuel injected engine, and loss of a fuel pump vs an injector to one cylinder.

Andries · May 17, 2023, 10:47:51 AM

Doc H;
You're doing an excellent job at describing immensely complex systems (and failures) with 'plain language', and even illustrations!
You've done this before, aintcha?
.
Thank you very much sir, from myself and prolly dozens of others who feel the same way.

Raider Bill · May 17, 2023, 02:02:11 PM

Quote from: Andries on May 17, 2023, 10:47:51 AM
Doc H;
You're doing an excellent job at describing immensely complex systems (and failures) with 'plain language', and even illustrations!
You've done this before, aintcha?
.
Thank you very much sir, from myself and prolly dozens of others who feel the same way.

Yes sir I agree!
Thanks Doc!

doc henderson · May 25, 2023, 11:41:12 AM

Coronary angioplasty and stents (msn.com)

doc henderson · May 25, 2023, 11:57:31 AM

not a heart attack, but did a little work in my shop.

His wife moved a saw that he then stepped on taking steaks out to the grill barefoot. he is my heating and air man and was in our troop with his son. we get lots of off the books help with our stuff.

Get those projects done. my barber and friend was dx. with a fast aggressive lymphoma. Dx. hospice, and gone within a few weeks. I will now finish the jewelry boxes we started for the girls in his life. He was adopted, a good athlete, in the Army, and taught Hunters safety for over 50 years. He also taught at the gun club. He spoke many "languages" depending on who was in the room. He was always sweet to my daughter Monique and she went with me to say goodbye. His barber shop was part of their house and the family replaced his chair with a hospital bed. God Speed Frank. I have promised him I will finish the 6 boxes made from a tree taken from his back yard.

Old Greenhorn · May 25, 2023, 01:00:33 PM

I am very sorry for the loss of your friend. That is a noble and worthy thing you are doing for his family. Good on ya!

Nice work on the foot, looks like he lost a bit of a chunk there. Maybe you should call it a 'wood and meat shop'?

doc henderson · June 30, 2023, 07:07:47 PM

I know that magic gets you to say eww and ahh. with permission I add a few recent issues.

Edit: sorry guys, I woke up at 3 am and decided that the pics of a patients leg before and after was too much. the point of this thread is to help you understand common issues. I posted the pic to shock a little and maybe even brag on the tough long repair that turned out well. I think the medical folks see this all the time, but I decided my motivation was less than professional and served no real purpose to the thread. an x-ray is a little less personal so I will leave this unless anyone objects. Doc!

Motorcycle vs dump truck. The rest of him was fine.

please do not try to beat that Magic Man!

Magicman · June 30, 2023, 07:40:44 PM

Am I allowed to say ouch??

doc henderson · June 30, 2023, 08:08:06 PM

of course!

doc henderson · June 30, 2023, 08:09:01 PM

both are doing well so you do not all worry.

Old Greenhorn · June 30, 2023, 09:08:07 PM

Quote from: Magicman on June 30, 2023, 07:40:44 PM
Am I allowed to say ouch??

I'll bet the PT said a lot more than that. Geez Louise!
I'd get guys like that in my ambo and if there pain was under control (they weren't screaming) and offer encouraging comments as we worked on them like "Well, it's gonna leave a mark, but you are gonna be OK", or "Man I bet that hurts!". One time time a guys that had a sense of humor I said "Man, I've had bad days but right now it really sucks to be you." he just replied "Ya ThinK?!" Ah good times. (No, I don't really miss it much.)

doc henderson · July 03, 2023, 12:48:33 PM

I have not been on as much, and no milling to speak of. with the shortage of health care folks and companies pinching pennies, I have worked 215 plus hours in June and slated the same for July. I post this here as colloquies are worried about that kind of work (hours) at my age. Thank you to the FF friends that have reached out personally by PM noticing my decrease in posting. Two more nights, then a few days off. Lots of turmoil and pain in the industry right now. Please be kind to the medical folks you meet along your day to day lives. My wife is a pharmacist. She is ready for us to retire. A special thanks to @red who seems to always be in tune with the needs of the friends on the forum.