What are lasting effects of "moderate degree of heart damage" after MI?

• By yarnkitty
• Reply 3701000
• January 13, 2013 at 8:04 am
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Moderate is a vague term that doesn't really tell you anything about the future. This is something you probably need to discuss with your doctor in an office visit and don't let him/her leave the room until you understand the information. It helps if you write down your questions ahead of time like the "will I always have chest pain and exercise intolerance?".

The actual scar in your heart doesn't hurt. Think of it like a scar on your skin that is kind of numb. What causes ongoing angina pain is lack of perfusion to the muscle. That can be from big vessels or the tiny ones. In your case with MVD it's the tiny ones. Things can be done with medication to help that pain. Many people take calcium channel blockers like amlodipine or diltiazem. Nitrates are the mainstay of treatment, both the short acting sublingual nitroglycerin and longer acting forms such as isosorbide mononitrate (Imdur) or nitroglycerin patches. Another possible source of chest pain is increased pressures in the ventricles caused by heart failure. This is treated with diuretics and the meds for heart failure such as ACE inhibitors.

There are some concrete measures of your heart performance that can be monitored over time such as ejection fraction and exercise tolerance. Again, you'll have to talk to your doctor to find out the relevance of all this to your case.

In my case, I had an anterior MI which was treated with stents almost immediately. I had 100% blockage of the LAD. That supplies the front side of the left ventricle and the pointy end of the heart (apex). I have scar that is visible on a nuclear perfusion scan, but my ejection fraction has recovered to the normal range (55-70%, mine was last measured as >65%). I have ongoing angina from spasms of the LAD past my stents. I take diltiazem and Imdur which help a lot. I take nitro spray for chest pain and pretreat for exercise or strenuous activities. My worst problem is that even relatively minor stress (like netflix isn't working right or looking for something and not finding it) can trigger chest pain. This makes it essentially impossible for me to work. I also get fatigued very easily. Otherwise quality of life is pretty good now that we have my meds where they need to be. I just have had to accept I cannot perform at the level I did previously. I am slower and have to minimize stress.

• By Artista
• Reply 3701059
• January 13, 2013 at 8:35 am
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Sigh... Likely verdicts out on how it affects everyone individually. In typical CAD, slight damage , we can compensate and make hearts stronger with exercise, diet, lifestyle changes and that can make many revovering feel perhaps even better than ever after an infarction. Unfortunately, you were fit (am i right) and had no blockages causing this. Remember, with CMVD this is cellular. Even if it is not the damage you feel, your body can perceive the lack of O2 that occurs with constricting vessels of this dysfunction that is what angina is, the symptoms may not go away entirely but you may overtime get improvement on handling it. So far the only self repair of these types of muscle cells(heart muscle cells, myocytes) are different than other muscle cells that once they are damaged or necrotic they don't regenerate enough to work but they are researching ways to help repair that in the future with stem cells, etc. I'm on cell phone and have a somewhat busy morning but I will find some references to illustrate what I wrote later.

Love n light
Annette

• By Jollie
• Reply 3701787
• January 13, 2013 at 1:04 pm
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Thanks ladies, I guess the CMVD trumps the moderate heart damage from the Type II MI, as far as nearly constant, unpredictable angina goes; it is those tiny vessels causing all the ongoing angina. As Yarnkitty stated "even minor stress can trigger chest pain"; so true of this crazy CMVD. I suppose even if I had not had the MI, I would still be about like I am now re inabilities and pain, since CMVD is present. I was just wondering if a person ONLY had MI with moderate damage, what would they experience as a result........not that the answers would change anything, just was wondering. I will try to pinpoint my cardio re: that question. (I always take a list to any of my Dr appts., and after, I write down their answers, so later when I forget some point I can look back on the list for clarification. All these meds to tone down my nervous system are toning down my memory big time) Love n light back at ya!! Jollie

• By girlscoutmom
• Reply 3702015
• January 13, 2013 at 2:31 pm
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I was told I have 20% heart muscle damage after my vaso-spasm M/I in 2003. I can't remember my ejection fraction as of my last testing, but I do remember the cardiologist was happy with the results. I only know the percent of heart damage, because I asked. I ALWAYS go to my visits with questions typed out on a sheet of paper. He answers everyone of them and always ends by saying, "Anything else on that paper?" In my case, it seems that exercise is the key. I am lucky in that I never have shortness of breath or pain while working out. But, that is not to say I don't get an occasional pain in my chest at other times. The thumping at night is most prevalent and my cardio is very much aware. Often I am forced to get up and take another 50 mg Toprol XL (my beta blocker) and it does the trick. Then, I always am sure to make mention of this upon my next doctor visit.
I agree with all who tell you to press your doctor for information, and don't leave until you get it. Good Luck!

• By Jollie
• Reply 3703105
• January 13, 2013 at 9:58 pm
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Also, how often is prudent to do followup echocardiogram? Yearly? My cardio doesn't really see much value in doing one now (1 year later) as my E.F. was 55-60% after the "event". But then I was on betablockers and couldn't that make your heart pump stronger than as I am without any of those currently? (I know, more questions for the Dr! :)

• By Artista
• Reply 3704741 · In reply to 3703105 by Jollie
• January 14, 2013 at 1:13 pm
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Hmmm.... Well, the question is what he is hoping to gain from echo. We know CMD is not visible per se, and you can have a normal EF yet still have diastolic issues. (As i illustrate below) I would think it prudent to do once a year, most especially if there were new symptoms, but what will it tell you? New symptoms yes!!! Otherwise?????

For me and my low BP, I keep a close eye on my diastolic number in BP. I am more concerned with that on an ongoing basis. Did you know 50% of heart failure patients have preserved EF or acceptable number for their EF? Crazy huh? Fifty percent!!!!! A friend said to me who is in cardiac field- well all I'd worry about is your EF? If that's good, your good! Really? Hmmmm.... Another sneaky thing here. Gettin tired of the Beast's sneakiness! It seems low bp is not a second thought... But it tells us something too. I had low BP BEFORE MEDS. My nitro brought it closer to normal. So, my systolic can be great but keep an eye on the diastolic functions too. I bet this is another atypical thing likely more prevelant with CMD that some misread.

FYI- Definition of Diastolic-
The bottom number, which is also the lower of the two numbers, measures the pressure in the arteries between heartbeats (when the heart muscle is resting between beats and refilling with blood).


I will find that article about preserved EF to post.

Xo
-A

• By cajngrl
• Reply 3705437
• January 14, 2013 at 4:51 pm
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55-60 ejection fraction is right under "normal".