diabetes What Ischemic Heart Disease

[Berta]

Ischemic heart disease, as a new AO presumptive, will certainly bring many more Agent Orange claims into the VA system.

With proof of AO exposure these claims should be very easy for the VA to rate and award.

The biggest problem with these claims that I foresee is that the VA will not have adequate evidence to determine IHD as many vets with IHD might have CAD or CHF in their records as well as other medical terms that in fact mean IHD diagnosis -but maybe the VA could misinterpret this.Or a C & P doctor could opine inaccurately on this AO disease.

I was talking to notable Vets lawyer Doug Rosinki a few weeks ago ago who had answered a vets question as to CHF-Congestive Heart Failure -which may not be ischemic heart disease at all. In his opinion-as ischemia has certain medical facets unlike other types of cardiomyopathy.He is right.

Terms like atherosclerosis, hyperlipedimia, peripheral aterial disease are some key medical terms that might most l;ifely indicate the type of heart disease one could have is, in fact, ischemia.

IHD is a broad term and accounts for the most prevalent type of heart disease in the USA.

However the new regs hopefully will define this disease better and hopefully veterans will not have problems proving they have this type of heart disease due to AO exposure.

“Caused by cholesterol deposits, which block arteries, ischemic (is-KEY-mic) heart disease, also called coronary artery disease or coronary heart disease, is still the single biggest cause of death in the United States, killing nearly 500,000 Americans each year. But the situation is changing. According to a study in the Sept. 25, 1998, New England Journal of Medicine, deaths from coronary heart disease dropped 28 percent among men and 31 percent among women between 1987 and 1994 alone. This drop is primarily due to improved care.

An estimated 14 million people in the United States have ischemic heart disease. Of these, as many as 4 million have few or no symptoms and are unaware that they are at risk for angina (angina pectoris), heart attack (myocardial infarction), or sudden death.

Angina Pectoris

Plaque deposits on the interior linings of the heart’s arteries lie at the root of <a href="http://www.acc.org/media/patient/chd/glossary.htm#angina">angina pectoris. The narrowed arteries prevent the heart from getting enough oxygen during exercise and the person experiences a chest pain beneath the breast bone—this pain is called angina pectoris. Mild or intense, the discomfort usually lasts only a few minutes. Every year, an estimated 350,000 new cases of angina occur. Today, angina pectoris can be dramatically reduced or eliminated by medications, heart surgery, or balloon dilation of narrowed arteries.”

From:http://www.acc.org/media/patient/chd/ischemic.htm

“Silent Ischemia and Ischemic Heart Disease

What is ischemia?

Ischemia (is-KE'me-ah) is a condition in which the blood flow (and thus oxygen) is restricted to a part of the body. Cardiac ischemia is the name for lack of blood flow and oxygen to the heart muscle.

What is ischemic heart disease?

It's the term given to heart problems caused by narrowed heart arteries. When arteries are narrowed, less blood and oxygen reaches the heart muscle. This is also called coronary artery disease and coronary heart disease. This can ultimately lead to heart attack.

Ischemia often causes chest pain or discomfort known as angina pectoris (AN'jih-nah or an-JI'nah PEK'tor-is).

What is silent ischemia?

As many as 3 to 4 million Americans may have ischemic episodes without knowing it. These people have ischemia without pain — silent ischemia. They may have a heart attack with no prior warning. People with angina also may have undiagnosed episodes of silent ischemia. In addition, people who have had previous heart attacks or those with diabetes are especially at risk for developing silent ischemia.

Having an exercise stress test or wearing a Holter monitor – a battery-operated portable tape recording that measures and records your electrocardiogram (e-lek"tro-KAR'de-o-gram [ECG]) continuously, usually for 24-48 hours – are two tests often used to diagnose this problem. Other tests also may be used.

From:http://www.americanheart.org/presenter.jhtml?identifier=4720

Ischemic cardiomyopathy results when the arteries that bring blood and oxygen to the heart are blocked. There may be a buildup of cholesterol and other substances, called plaque, in the arteries that bring oxygen to heart muscle tissue. Over time, the heart muscle does not work well, and it is more difficult for the heart to fill and release blood.

Ischemic cardiomyopathy is a common cause of congestive heart failure. Patients with this condition may at one time have had a heart attack, angina, or unstable angina. A few patients may not have noticed any previous symptoms.

Ischemic cardiomyopathy is the most common type of cardiomyopathy in the United States. It affects approximately 1 out of 100 people, most often middle-aged to elderly men.”

From:

http://www.nlm.nih.gov/medlineplus/ency/article/000160.htm

also

Diabetic ischemic cardiomyopathy can cause a heart attack without a level of pain that would indicate heart attack. An EKG can immediately reveal whether this was silent ischemic heart attack or not.

Also severe peripheral neuropathy and arterial disease is another factor that can limit the amount of pain a heart attack victim can have.

None of this information is meant to alarm anyone.

But we and our significant others need to be aware of these things.

And AO vets filing for Ischemic heart disease might find this information helpful.

[jbasser]

I was offered it last summer but I declined for now.

It is a very invasive procedure where they open you up and cut channels in the heart muscle. The Vessels attach and you are supposed be better offf.

It sounds good but I was in no shape to do it then.

J

[hawkfire27]

As long as your type of heart disease is ischemic in nature -you can claim it due to AO exposure.

Most heart disease is ischemic but this is something your medical records will clarify.

Hopefully when the VA puts this proposed rule into the Federal Register they will define what they conisder ischemic heart disease.

I think it will be rated same as atherosclerotic heart disease but cannot predict how VA will handle this new AO presumptive.

Both Hodgkins and Non Hodgkins are AO presumptive disabilities-have you cl;aimed them?

Hi Berta, Just thought I would let you know that when we put in for a IHD claim we were told to put in for CAD as well.

So we did.... What we got back from the VA was one claim for IHD and one claim for CAD secondary to IHD, this is how the VA interpreted our claim so perhaps they are going to consider it two seperate conditions. Another thing to note is our VA cardiologist diagnosed both CAD and IHD as separate conditions in the medical records, IHD was Diagnosed as Ischemic Heart.....IHD is then listed elsewhere in the medical records as a risk factor for CAD, sooooo, it looks like the VA is trying to kept these two things spearate.

And something else was the Agent Orange Exam people put down that my husband had CAD "and" presumptive Diabetes II in the Exam notes, note he didn't say the CAD was presumptive and he made no mention of the IHD elsewhere in the notes......

Anyway just thought it was an interesting point....

[hawkfire27]

I was offered it last summer but I declined for now.

It is a very invasive procedure where they open you up and cut channels in the heart muscle. The Vessels attach and you are supposed be better offf.

It sounds good but I was in no shape to do it then.

J

hey jbasser, I think you got EECP confused with Laser Revascularization.

EECP is external counterpulsion, this is really good and non-invasive, basically just pressure cuffs like getting your BP taken, but the cuffs are on your legs, it takes about 35x 1 hour sessions but it works pretty good stops the angina and can help you cut down on meds.... What happens is it feeds oxygen rich blood into your heart which helps your heart form new vessels on it's own to naturally bypass the bad vessels that cause angina.

[Sgt Schmidt]

Hi Berta, Just thought I would let you know that when we put in for a IHD claim we were told to put in for CAD as well.

So we did.... What we got back from the VA was one claim for IHD and one claim for CAD secondary to IHD, this is how the VA interpreted our claim so perhaps they are going to consider it two seperate conditions. Another thing to note is our VA cardiologist diagnosed both CAD and IHD as separate conditions in the medical records, IHD was Diagnosed as Ischemic Heart.....IHD is then listed elsewhere in the medical records as a risk factor for CAD, sooooo, it looks like the VA is trying to kept these two things spearate.

And something else was the Agent Orange Exam people put down that my husband had CAD "and" presumptive Diabetes II in the Exam notes, note he didn't say the CAD was presumptive and he made no mention of the IHD elsewhere in the notes......

Anyway just thought it was an interesting point....

If this is the case, should I file for CAD as well? I was dx'd with CAD back in 91. Also, not to add fuel to the fire, during my recent visit with my family doc yesterday I was told I have anemia. Is this possibly related to AO exposure?

[Berta]

Hawkfire-with established AO exposure- your husband would have SC basis under the new proposed regs for IHD due to AO or for CAD as secondary to his AO DMII. Whch would need medical evidence of the association.

I had to recheck my husband's med recs as to his CAD- it was found as ischemic in nature due to his long standing atherosclerosis due to his untreated DMII.

This is what is bothering my about how they might word the proposed regs:

"And something else was the Agent Orange Exam people put down that my husband had CAD "and" presumptive Diabetes II in the Exam notes, note he didn't say the CAD was presumptive and he made no mention of the IHD elsewhere in the notes......"

The CAD has to be found secondary to DMII by medical evidence. I have seen the VA try to deny diabetic heart disease by saying the heart disease began prior to the AO DMII diagnosis.

They probably failed to diagnose the DMII properly in some of these cases prior to development of heart disease due to it.

Ischemic heart disease is a more refined definition of CAD due to atherosclerotic involvement.

Ischemia means blockage -due to clotting or narrowed arteries due to plaque.

I think many IHD vets will need to make sure they have had an ECHO done to prove IHD as an EKG doesnt accurately reveal this type of blockage at all.

I cant wait for the new regs to be in the FR.

[billy2]

Hawkfire-with established AO exposure- your husband would have SC basis under the new proposed regs for IHD due to AO or for CAD as secondary to his AO DMII. Whch would need medical evidence of the association.

I had to recheck my husband's med recs as to his CAD- it was found as ischemic in nature due to his long standing atherosclerosis due to his untreated DMII.

This is what is bothering my about how they might word the proposed regs:

"And something else was the Agent Orange Exam people put down that my husband had CAD "and" presumptive Diabetes II in the Exam notes, note he didn't say the CAD was presumptive and he made no mention of the IHD elsewhere in the notes......"

The CAD has to be found secondary to DMII by medical evidence. I have seen the VA try to deny diabetic heart disease by saying the heart disease began prior to the AO DMII diagnosis.

They probably failed to diagnose the DMII properly in some of these cases prior to development of heart disease due to it.

Ischemic heart disease is a more refined definition of CAD due to atherosclerotic involvement.

Ischemia means blockage -due to clotting or narrowed arteries due to plaque.

I think many IHD vets will need to make sure they have had an ECHO done to prove IHD as an EKG doesnt accurately reveal this type of blockage at all.

I cant wait for the new regs to be in the FR.

Bertha,

I had a 90% blockage and they put a stent in to correct the problem. The doctors call my condition CAD but I found the term "ischemia"

mentionrd twice in my medical notes. I hope this would fall under the IHD ruling.

Bill