Ischemic Heart Disease

[georgiapapa]

Up until a couple of days ago, I never thought I had any heart problems other than a mitral valve prolapse. Earlier this week I had been to my private primary care doctor for a cough and intermittent chest pain. I had undergone a stress test and an echo of my heart in July by my cardiologist and was told everything looked fine so I did not think my recent chest pains were caused by heart problems. My pcp did a chest x-ray and EKG and said it wasn't my heart and he diagnosed me with pleurisy and bronchitis.

Wednesday night of this week I started experiencing severe chest pains and my wife called 911. I took an ambulance trip to the emergency room. After running some blood tests, I was told my cardiac enzymes were elevated and the cardiologist performed a heart cath. After the heart cath, the cardiologist informed me she had placed two stents in my heart due to a 99% blockage in one part of my LCD and 80% blockage in another part of my LCD. I believe the LCD she was referring to is the left anterior descending artery of my heart. My cardiologist advised that I did not have a heart attack but she said I was on the verge of a serious heart attack prior to placement of the stents. I am currently in the heart unit of my local hospital but I hope to be discharged this morning.

I am totally lost as to what I need to do in regards to a claim for AO related IHD. I am a boots on the ground Vietnam veteran so I think I would qualify under the AO presumptive policy. Any guidance anyone can give as to what is needed and how to proceed at this point in time would be appreciated. Even if I would be rated at 0% service connected (since I did not experience a heart attack), at least this would make benefits available to my wife in the event I later had a fatal heart attack. Your thoughts ans suggestions would be appreciated.

Georgiapapa...

[SP4RVN1971]

The first of this last July, I started having chest pains. The pain was constantly moving around from the front to my back and into neck. It was't a stronge pain ,but I knew that it was the on coming of a blockage. Since this was not my first rodeo, I called my heart doc. and we did the normal EKG, Stress test, all the tests. My heart look great, the pain continued and got worst, so I went to the local Pharmacy and told them that my Heart doc want me to have Nitro. They gave a small bottle and when I had my next attack, i knew! Since I had two stents already, I knew what to look for and went to my Heart hospital. Sure enough 85 % blockage.

Sometimes you got to lisen to your body!

I know at least one friend that did not, God rest this soul!!

[Berta]

I certainly defer to these excellent comments but I don't understand why the VA puts so much weight on the EKGs,METS and ECHO tests for these heart disease claims,if those findings are not really accurate and no cath was done.

I lost a good friend last year to a sudden heart attack.All her friends were only aware of her very high cholesterol ,which was being medicated . Per her relatives, an autopsy revealed death caused by cardio blockages due to plaque from cholesterol.

She had very poor eating habits and was not a veteran. I guess a prior ECHO or EKG would not have saved her.

VA even depends of the EF ,ejection fraction percent, too in their rating criteria but apparently that is also just a guess.

Well put SPARVN1971:

"Sometimes you got to lisen to your body!"

And i never leave my doc's office without copies of any test results.My last LDL and the other stuff for cholesterol was 'perfect' she said (I had the CBC and the ast /alt test too) but I asked her exactly what she meant ,as those test results are often confusing for me to comprehend.

I checked the results out at a good web site too.

I do believe that most doctors don't mind being asked questions at all.

" I will ask why the previous cardio tests from July did not reveal the blockages. I will let you know what she tells me."

I am sure there is a very sound reason and others have explained that quite well to me here, but ,since this is an AO claim, and if there is any potential at all for being a Footnote One Nehmer claim, which I dont believe it would be, still, I guess the footnote one AO rating would have been "0" % SC IHD up to the date of the stent placements.

Edited September 15, 2012 by Berta

[Chuck75]

Up until a couple of days ago, I never thought I had any heart problems other than a mitral valve prolapse. Earlier this week I had been to my private primary care doctor for a cough and intermittent chest pain. I had undergone a stress test and an echo of my heart in July by my cardiologist and was told everything looked fine so I did not think my recent chest pains were caused by heart problems. My pcp did a chest x-ray and EKG and said it wasn't my heart and he diagnosed me with pleurisy and bronchitis.

EKG's may not show anything until significant damage exists. I've had 24 hour "halter tests" that showed a "normal" result. (This is years after open heart surgery, an LVEF of about 30% at the time, and long standing records showing "Bradycardia".)

On the other hand, cath based tests showed damage, based upon internal heart pressure waveforms, along with blockages.

I'd think that the PCP screwed up, or relied on a faulty diagnosis. Pleurisy symptoms can be a sign of heart distress and pending failure.

Infections and the resultant immune reactions can cause types of "swelling" or irritation that increases the chances of a heart attack.

Cutting to the chase, you certainly should file for A/O presumptive heart disease. You are/were hospitalized, for heart related problems. The stint implantation counts, and you might very well meet at least the temporary scheduler requirements for 100%. Down the road a bit, further testing, etc. may show the extent of heart damage, and be evidence for a permanent rating.

You may not have experienced (to your knowledge) a heart attack. On the other hand, the first attack or two may be "silent", with the only obvious symptoms something like fatigue.

"cardiac enzymes were elevated" is an indication of a "heart attack"(even a silent one) and significant evidence that heart damage is possible. The VA's definition of IHD is not just confined to heart damage, and extends to the arteries that feed the heart. If nothing else the "preventive" drugs that you will be taking are not cheap, and getting things service connected reduces your drug costs considerably.

Angina often feels like indigestion, even though it might just "go away" with a drink of cold water. There are other common less than obvious symptoms that are often only considered significant in retrospect..

Wednesday night of this week I started experiencing severe chest pains and my wife called 911. I took an ambulance trip to the emergency room. After running some blood tests, I was told my cardiac enzymes were elevated and the cardiologist performed a heart cath. After the heart cath, the cardiologist informed me she had placed two stents in my heart due to a 99% blockage in one part of my LCD and 80% blockage in another part of my LCD. I believe the LCD she was referring to is the left anterior descending artery of my heart. My cardiologist advised that I did not have a heart attack but she said I was on the verge of a serious heart attack prior to placement of the stents. I am currently in the heart unit of my local hospital but I hope to be discharged this morning.

I am totally lost as to what I need to do in regards to a claim for AO related IHD. I am a boots on the ground Vietnam veteran so I think I would qualify under the AO presumptive policy. Any guidance anyone can give as to what is needed and how to proceed at this point in time would be appreciated. Even if I would be rated at 0% service connected (since I did not experience a heart attack), at least this would make benefits available to my wife in the event I later had a fatal heart attack. Your thoughts ans suggestions would be appreciated.

Georgiapapa...

[Chuck75]

"quote name='Berta'

I certainly defer to these excellent comments but I don't understand why the VA puts so much weight on the EKGs,METS and ECHO tests for these heart disease claims,if those findings are not really accurate and no cath was done.

I don't understand why the VA puts so much weight on the EKGs,METS and ECHO tests for these heart disease claims."

They cost less, may favor the VA attitude of minimizing claims, and can be more easily done by VA facilities that do not have serious heart related capability.

(My local VAMC is a case in point. The "Cardiologist" does not seem to be board certified, and the backup regional heart center is half the distance from me, in the opposite direction.

I also doubt that the local VAMC is qualified to administer certain drugs (if they even have them) that can, in emergency, dissolve blockages. TCB is one of the drugs.

Edited September 15, 2012 by Chuck75

[georgiapapa]

Berta,

I talked with my cardiologist and asked why there was no indication of blockages during my diagnostic tests in July. She seemed truly concerned and said she was going to look into the matter because there should have been some red flags. Apparently, her cardiology group has someone who reviews the tests for the cardiologists and prepares reports of their findings for them. I am not sure of the professional background of the person performing the reviews.

I advised my cardiologist that I was concerned about the reliability of the echo and ECG versus the cath procedure. She told me that an ECG and echo have an important role in diagnosing cardiac problems but are not as reliable as other diagnostic tests in situations such as mine. My cardiologist characterized my blocked artery symptoms as "atypical" because the only symptom I experienced on the night I went to the emergency room was a sharp stabbing pain in the center of my chest. I did not have any pain radiating to other parts of my body, no profuse sweating, no crushing feeling in the center of my chest, etc. Due to my lack of the standard symptoms, my cardiologist instructed me to contact her immediately if I experience any severe chest pains in the future and she will call the hospital and schedule me for a cath procedure upon my arrival in the emergency room.

Georgiapapa...

[Berta]

There are many markers for potential heart disease.

High Triglyceride levels , done as part of comprehensive CBC blood work, for example,

http://circ.ahajourn...0?view=full.pdf

Here is another list of some potential markers .It is from Wikipedia -notthe best medical source)but the citations look OK:

http://en.wikipedia....ac_marker#Types

I mentioned my Cholesterol lab tests here because the LDL marker is within this list.

On my lab results it says “< (less than) 130 -Low Risk of coronary heart disease”

My results were 105 LDL.

As you all know I had to prove my husband had heart disease, never diagnosed or treated by VA for 6 years.

Although I had proof of his initial heart attack (while employed at VA) I also did extensive research on his blood work readings too, and they alone (even without EKGs or ECHO) held some red flags.

I also had to prove he had undiagnosed and untreated DMII, and in that case as well his CBC values indicated markers for diabetes.

But 'markers' for any disability is just that. They are not the best diagnostic tool but they can be the best indication that a doctor needs to watch out for any significant value changes in the results and consider what they potentially might indicate. They can show evidence of a metabolic syndrome (I used my research for that for both above claims I had along with the medical records indicating this syndrome in certain blood values) and also indicate coronary syndrome.

The GPBB test on the linked list for example is a good indicator of a cardiac event, even if the trditional symptoms are missing.

:

“GP-BB is one of the "new cardiac markers" which are discussed to improve early diagnosis in acute coronary syndrome. A rapid rise in blood levels can be seen in myocardial infarction and unstable angina. GP-BB elevated 1–3 hours after process of ischemia. “

In my husband's case, the ER certificate stated "diaphoretic",after a brief loss of consciousness,but he had no chest pain.

The EKG VA ignored revealed possible ischemia and an obvious change in the lead pattern from his last EKG.

The word "diaphoretic", a symptom the doctors ignored, was critical to that claim ( 1151/FTCA)

Chuck said it all: He gave 3 solid reasons why veterans do not always get the best testing and therefore,don't get the benefit of early intervention, and,best of all sometimes , good preventive care.

Georgiapapa -I sure agree with this too....

“Apparently, her cardiology group has someone who reviews the tests for the cardiologists and prepares reports of their findings for them. I am not sure of the professional background of the person performing the reviews. “

I witnessed that many times when my husband was a VA patient.But it involved doctors reviewing findings incorrectly.

It doesn't surprise me that your cardio doctor is concerned. Unfortunately anyone with the metabolic syndrome evident in their blood work , (cholesterol values and triglycerides are in a High range) could have heart disease beginning as secondary to DMII, a metabolic disorder. Some DMII patients with CAD are even susceptible to Sudden Death Syndrome and/or heart attack events with minimal or no chest pain.

I am not a doctor and I do believe the VA as well as non VA doctors save lives very single day.

But as proactive as we must be over our claims, we also need to be proactive with understanding our medical care.

Edited September 16, 2012 by Berta