Heart Disease Experts

[jbasser]

I have a RVN in Country combat Veteran who has heart disease and may need a Procedure to replace a Valve damaged because of Acquired Aortic Stenosis.

This man has been my best friend for nearly 20 years so this makes this issue personal and is on the top of my list.

I need to know the types of Heart diseases under the new regs as Ischemic heart disease.

Any Replies are appreciated, especially from Med Pros Like Bergie.

JB

[*Bergie*]

I have a RVN in Country combat Veteran who has heart disease and may need a Procedure to replace a Valve damaged because of Acquired Aortic Stenosis.

This man has been my best friend for nearly 20 years so this makes this issue personal and is on the top of my list.

I need to know the types of Heart diseases under the new regs as Ischemic heart disease.

Any Replies are appreciated, especially from Med Pros Like Bergie.

JB

John,

Ischemic heart disease is simply poor blood supply to the heart muscle. With aortic stenosis the bigger worry is the size of his left ventricle. This can lead to congestive heart failure that may or may not improve with the replacement of the valve. For sure though he should feel better when the new valve is in. I would recommend that he get an echo, and stress test ASAP if he has not already done so.

John, PM me with a little more info like, smoking history, other health problems, medications, ect.. I can better advice with this info...

Thank you,

Bergie

[Chuck75]

Acquired Aortic Stenosis translates as damage caused by such things as rheumatic fever, or other "low grade" infections that may not have been noticed at the time, or treated. Unless there is a history of a disease that causes this problem in service medical records, I believe that this disease might be used by the VA to say that any heart ischemia is due to the disease, rather than A.O. exposure. (IMO's etc. will likely be required to try and service connect this disease.)

As to what is included in the VA IHD package-- no one outside of the VA likely knows--

But, there was a precedential case in 2000 concerning a POW veteran that tied various conditions to IHD.

There also was a VA internal letter in the last few months that gave some direction in this area, although ischemia claims were delayed pending new regs. I remember one statement in the letter that directed RO's not to schedule C&P's if medical evidence of ischemia already existed in medical records. Assuming there is enough in the records to rate, naturally. To me such things as coronary artery disease, left ventricle efficiency, enlarged heart and a plethora of other heart related problems are associated with ischemic heart disease.

ischemic heart disease is a result. I believe that the thinking was that IHD would cover a whole group of heart problems that are currently "scheduler".

I.E. the progression would be A.O. exposure (presumed or proved) Various heart related problems resulting in IHD.

Diabetes is considered to be related to the causes of heart disease, although the VA tries to disconnect the two.

When both are present, such things as peripheral arterial disease also occur more often. I believe there was a specific mention that the VA will not consider peripheral arterial disease as related to IHD.

[Commander Bob]

I have a RVN in Country combat Veteran who has heart disease and may need a Procedure to replace a Valve damaged because of Acquired Aortic Stenosis.

This man has been my best friend for nearly 20 years so this makes this issue personal and is on the top of my list...

JB

Sorry to hear about your friend. Glad he is addressing his heart issue. I researched the AO connections, and found the same things that I'm sure you already know. As a fellow combat vet, please give him my regards . I look forward to reading about his R&R fishing therapy, after the surgery. The Largemouth bass should be spawning in your neck of the woods soon, if not already. When your friend gets the surgery behind him, he can hook one later this season. My most positive thoughts are with him.

Edited April 13, 2010 by Commander Bob

[Berta]

I dont know if the claim would conform to the IHD regs-because they specifically raise the myocardium-

the musclular area of the heart and I dont know if that includes the heart valves.

"According to Harrison's Principles of Internal Medicine (Harrison's

Online, Chapter 237, Ischemic Heart Disease, 2008), IHD is a condition

in which there is an inadequate supply of blood and oxygen to a portion

of the myocardium; it typically occurs when there is an imbalance

between myocardial oxygen supply and demand. Therefore, for purposes of

this regulation, the term ``IHD'' includes, but is not limited to,

acute, subacute, and old myocardial infarction; atherosclerotic

cardiovascular disease including coronary artery disease (including

coronary spasm) and coronary bypass surgery; and stable, unstable and

Prinzmetal's angina. Since the term refers only to heart disease, it

does not include hypertension or peripheral manifestations of

arteriosclerosis such as peripheral vascular disease or stroke."

http://www.regulations.gov/search/Regs/hom...A-2010-VBA-0005

myocardium

[mī′ōkär′dē·əm]

Etymology: Gk, mys, muscle, kardia, heart

a thick contractile middle layer of uniquely constructed and arranged muscle cells that forms the bulk of the heart wall. The myocardium contains a minimum of other tissue, except blood vessels, and is covered interiorly by the endocardium. The contractile tissue of the myocardium is composed of fibers with the characteristic cross-striations of muscular tissue. The fibers are about one third as large in diameter as those of skeletal muscle and contain more sarcoplasm. They branch frequently and are interconnected to form a network that is continuous except where the bundles and the laminae are attached at their origins and insertions into the fibrous trigone of the heart. Myocardial muscle contains less connective tissue than does skeletal muscle. Specially modified fibers of myocardial muscle constitute the conduction system of the heart, including the sinoatrial node, the atrioventricular (AV) node, the AV bundle, and the Purkinje fibers. Most of the myocardial fibers function to contract the heart. The metabolic processes of the myocardium are almost exclusively aerobic. Many key enzymatic reactions of the heart, such as the citric acid cycle and oxidative phosphorylation, take place in the highly concentrated myocardial sarcosomes. The process of oxidative phosphorylation produces adenosine triphosphate (ATP), the immediate energy source for myocardial contraction. Oxygen, which significantly affects ATP production and contractibility, is a critical metabolic component of the myocardium, which consumes from 6.5 to 10 mL/100 g of tissue per minute. Without this oxygen supply, myocardial contractions decrease in a few minutes. The myocardium maintains a relatively constant level of glycogen in the form of sarcoplasmic granules. Compare epicardium. See also cardiac muscle. myocardial, adj."

http://medical-dictionary.thefreedictionary.com/myocardium

I agree with Chuck.

An IMO could possibly reveal that he does have IHD,which is compounded by the valve problem.

There are 38 comments so far at the Federal Register site-I havent read them all-maybe someone has raised this type of issue.

When I read over the regs to comment on them -I was surprised that they were very concise.

My biggest fear was they could leave too much lee way for the VA because heart disease is such a generic term.But IHD isn't generic and their definition is perfect.

But only for IHD vets.

Does he get any pritvate care and maybe this could lead to a private opinion that would not be too costly?

Edited April 13, 2010 by Berta

[Berta]

gee hold that phone!

Did he have rheumatic fever as a child?

Was that the etiology of his problems now? Was it listed on his entrance exam? Did he have anything at all in his SMRS (shorttness of breathe etc) that could have been results of rheumatic fever? as the cause of his heart disease now?

a long shot maybe- but sometimes the long shots are the keys to what we need.

Does he have his complete SMRs?

[jbasser]

The Echo findings are revelant. Has always been in good health, never had Reumatic Fever.

His Aorta and Valve are calcified and he had Cad to boot.

Time to drop the hammer.

J