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...

[georgiapapa]

Berta,

Thanks for your detailed reply. In response to your questions, the following is offered:

I have not been diagnosed with thrombotic thrombocytopenia purura or thrombocytopenia.

I have been taking medication for several years for elevated cholesterol and triglycerides. I have taken medication at times for iron deficient anemia but it has been several months since I needed the medication.

I do not have diabetes.

The cardiologist who signed the reports is the same person who performed the tests in July and installed my stents in September.

My cardiologist is a private doctor. I have not received any treatment or exams at the VA for heart problems except for a ECG during my annual VA physical in March 2012 which was normal.

I have not received any chemo for my myeloma.

Multiple Myeloma is a "plasma cell dyscrasia" and plasma cell dyscrasia is listed in my patient history. My cardiologist is aware of my multiple myeloma diagnosis.

The information you provided to me will add to the questions I have for my cardiologist on Thursday. Again, thanks for taking the time to give such a detailed response.

Georgiapapa...

[Berta]

I forgot to add:

one of the tests stated:

"Isotope study to follow”

I assume this will be a PET scan-

positron emission tomography- and this test will certainly give more info to your doctor.

I do feel you are getting good care and assumed it was not from the VA but I wasn't sure.

The PET test is only a little more time consuming than a CT scan but similar to it.

You might get a low IHD rating but that is a GOOD thing because so many Vietnam vets are dying from heart disease an you do have other AO claims pending.

Has any doctor associated the PN directly to the Myeloma with a full medical rational? If not maybe your cardio doctor would provide to you,if needed, an IMO for that claim , and hopefully at a reasonable fee.

[stillhere]

Georgia, My injection is 42% last time I was check. To me it looks like your dr is doing a great job.

This need for stents and the blockages with the chest pain will need to be rationalized.

If your were to get rated for this unless your mets are out of wack I would say 0-10%

Your condition and the reports are very confusing to me.

My reports on all medical tests point directly to my condition and all check and balance. Yours don't and I for one wonder why??

But hey that is just me your dr really does seem to have a handle on it.

Stillhere

[georgiapapa]

Berta,

I had a full body PET scan in April at the Myeloma Institute in Little Rock, Arkansas. I have had 4 or 5 PET scans since September 2010 and about the same number of full body MRIs. I am going to look back at the PET scan and MRI reports to see if anything was mentioned about my heart. I do not recall anything being mentioned about my heart. The doctors were more focused on finding lesions or tumors in my bones but I would think the radiologists or technicians who performed the tests would have mentioned it if anything unusual with my heart was detected.

I agree it's better to have a heart with minor problems and a low disability rating than a heart with major problems and a high disability rating. I will gladly take a 0% rating and no more heart problems than a 100% rating and increasing heart problems.

In regards to my PN association with my multiple myeloma, I submitted an IMO from a board certified neurologist with over 30 years experience. He is also one of the associate professors at the local medical school and has an impressive educational and professional background. I originally went to him in 2009 when my PN starting progressing from my toes into the rest of my feet. He ran several blood tests on me including the test that indicated I had m-protein or myeloma protein in my blood. He then referred me to an oncologist/hematologist. I returned to see him in 2011 because my PN had progressed from my feet into my legs. After ruling out stenosis/radiculopathy with a CT myelogram, reviewing EMG and Nerve studies, conducting a thorough clinical examination and reviewing medical literature, he stated in the IMO that my PN was "more likely than not" secondary to my myeloma disease.

I will ask my cardiologist if she has an opinion regarding the connection between my myeloma and my PN but she will probably do like some of my other doctors and defer to the neurologist.

Hopefully I will find out within the near future if the VA agrees with my neurologist.

Georgiapapa...

[Chuck75]

From personal experience - -

Blocked arteries or partially blocked ones may not cause noticeable symptoms, until they get rather "serious".

Depending upon a whole plethora of things, an individual may lead a "normal" life, with seemingly no problems,

or perhaps symptoms so minor that they don't trigger concern or investigation.

I carried an airman's first class medical for decades, with only one "oddity" that was not disqualifying.

This the same medical exam and FAA certificate that an airline pilot must pass and carry.

For two or more decades, the only clue that something was not quite as it should be had to do with extended moderate effort and fatigue.

Since I worked in a semi sedentary position, where only occasional short term physical labor was involved, that was considered to be more or less normal.

A perhaps missed clue was that a cold drink of water tended to completely relieve the symptoms.

One weekend evening, about eleven years ago, I had walked briskly all over the local WM superstore with my wife with no signs of any problems. I woke up early in the AM, with moderate Angina.

Eventually, after trying several things to see of that would make the pain go away, and not working, I ended up getting my wife to drive me to the local hospital.

After the usual undesired delays, the emergency room staff finally decided that indeed, I was likely having the precursors of a heart attack. Well after treatment was started, the angina

changed to the classic "bar of pain" across my chest. A plethora of drugs were administered, including morphine and one that caused my blood vessels to burn slightly.

Finally, a clot buster referred to as TCB was given. That provided relief. When I woke up the next day, while still in intensive care, I was told that I indeed had a heart attack, and a blood clot was the culprit.

Estimates of damage were in the 50% range. The local staff cardiologist was Gung Ho to do a cath the next day. Since the hospital was just beginning to get into this sort of thing, I had to decline.

My cardiologist of long standing happened to be on staff of the regional heart center, less than half an hour away, and I had previous caths at the center. So, that where I ended up getting another cath and a stint. (There were/are reasons why you don't want to do a cath soon after such emergency treatment, unless there is no choice.)

(Why do such things seem to always happen at the most inconvenient times, and when skeleton crews man emergency services?)

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]

Chuck, that was a very serious experience and fortunately you got fast medical care that could have definitely saved your life!

You stated "Blocked arteries or partially blocked ones may not cause noticeable symptoms, until they get rather "serious"."

YES. So true. and often can be the cause of a major stroke,if not a major cardiac event.

Georgiapapa, PETS are often specific to a particular disability.

You have very good evidence for the PN claim.

It is possible that past PETs you had were solely for the cancer and not focused on any potential heart problems.

And I could be quite wrong about the PET test. I assumed they meant PET by the "isotope study to follow".

Edited September 19, 2012 by Berta