Heart attack

My Heart Attack

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Friday, December 03, 2010

Cardiology Department Diagnosis

This morning I had a copy of the letter the Milton Keynes  Hospital cardiology department sent my G.P. following my recent appointment. The following is a report in that letter. If it is in any way helpful to anyone who has had a similar medical problem, had a heart attack, suffers from angina, or in any way identifies with my medical history, then I am recording it here.

Diagnosis list

'1. Myocardial infarction 2006 (angiogram at Bedford, conservative management.)
2. DSE 2008: no inducible ischaemia.
3. Hospital admission with troponin negative chest pain and equivocal exercise test- September 2010.
4. DSE October 2010: negative for inductible ischemia.

Medication List
Asprin 75 mg od
Pravastatin 20mg od
Isosorbide mononitrate 20 mg

Plan
1. GP to please discontinue isosorbide mononitrate and commence Amplodipine 5 mg od- uptitrating to 10 mg od
2. GP to please commence proton pump inhibitor
3. GP to please commence ACE inhibitor if no contra-indications.

On his admission his troponin was negative and he went on to have an exercise tolerance test which showed no gignificant changes, although there were some equivocal lateral ECG changes. He had no limiting chest pain but managed 6 minutes, 7.3 METS.

Cardiovascular system examination was unremarkable and his blood pressure today was 129/72.

He had a dobutamine stress echocardiogram on 16th October which was negative for inducible ischaemia.'

 I have Googled 'ischemia' as I had no idea what it meant, and this is what I found:

'Myocardial ischemia is an intermediate condition in coronary artery disease during which the heart tissue is slowly or suddenly starved of oxygen and other nutrients. Eventually, the affected heart tissue will die. When blood flow is completely blocked to the heart, ischemia can lead to a heart attack. Ischemia can be silent or symptomatic. According to the American Heart Association, up to four million Americans may have silent ischemia and be at high risk of having a heart attack with no warning.

Symptomatic ischemia is characterized by chest pain called angina pectoris. The American Heart Association estimates that nearly seven million Americans have angina pectoris, usually called angina. Angina occurs more frequently in women than in men, and in blacks and Hispanics more than in whites. It also occurs more frequently as people age—25% of women over the age of 85 and 27% of men who are 80-84 years old have angina.

People with angina are at risk of having a heart attack. Stable angina occurs during exertion, can be quickly relieved by resting or taking nitroglycerine, and lasts from three to twenty minutes. Unstable angina, which increases the risk of a heart attack, occurs more frequently, lasts longer, is more severe, and may cause discomfort during rest or light exertion.

Ischemia can also occur in the arteries of the brain, where blockages can lead to a stroke. About 80-85% of all strokes are ischemic. Most blockages in the cerebral arteries are due to a blood clot, often in an artery narrowed by plaque. Sometimes, a blood clot in the heart or aorta travels to a cerebral artery. A transient ischemic attack (TIA) is a "mini-stroke" caused by a temporary deficiency of blood supply to the brain. It occurs suddenly, lasts a few minutes to a few hours, and is a strong warning sign of an impending stroke. Ischemia can also effect intestines, legs, feet and kidneys. Pain, malfunctions, and damage in those areas may result.'
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