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...

[jvretiredvet]

There's been a lot of talk all around the subject, but I'd recommend a reread of the echo report that states "biatrial enlargement" combined with the phrases in the DC 7xxx series that speaks of "evidence of cardiac hypertrophy or dilatation on electrocardiogram"

Berta and others,

Today I obtained copies of some of my medical records from my cardiologist's office including the records for my July 2012 diagnostic tests and September 2012 records of my recent heart cath and stent placement. I have an appointment this Thursday September 20th with my cardiologist where I will have a lot of questions. Below is some of the comments found in the various reports:

July 10, 2012 Reports:

MYOCARDIAL SCAN (Lexican/Thalium stress test) "There are no areas of ischemia or scar tissue seen." IMPRESSION: "Normal myocardial scan. No change from the prior exam of 11/09/10."

EJECTION FRACTION: "The ejection fraction is calculated at 74%."

LEFT VENTRICULAR WALL MOTION: "Left ventricular wall contractility is noted to be normal with no areas of hypokinesis or akinesis. There is no paradoxical wall motion seen to suggest left ventricular wall aneurysm.."

IMPRESSION: "Normal left ventricular wall motion."

NOTE: This report is signed by a local radiologist.

LEXISCAN WORKSHEET (Screening for IHD) CLINICAL INFORMATION: "Patient with DOE/Fatigue and history of hypertension, hyperlipidemia." INTERPRETATION: "Resting electrocardiogram reveals sinus bradycardia at 51 bpm with a resting blood pressure of 128/64 mmHg. The patient received IV Lexiscan per protocol. Maximum increase in heart rate to approximately 100 bpm. There was quite a bit of artifact during the completion of the Lexiscan. Minimum drop in systolic blood pressure was to 90/60 mmHg. No significant ST changes were noted above the baseline abnormality when adjusting for the artifact intervening. No chest pain was experienced." CONCLUSION: "Nondiagnostic electrocardiographic response to IV Lexiscan." "Pharmacologic effect achieved." "Isotope study to follow." NOTE: This worksheet is signed by my cardiologist.

ECHOCARDIOGRAM - INDICATION: " sob, cp, htn, dizziness." LEFT VENTRICULAR STRUCTURE: "Normal in size and shape." LEFT VENTRICULAR FUNCTION: "Ejection fraction is estimated at 60-65%. No regional wall motion abnormalities were noted." LV DIASTOLIC FUNCTION: "Abnormal diastolic function with impaired relaxation." RV STRUCTURE & FUNCTION: "Size and function are normal." LA STRUCTURE: "Left atrium is mildly enlarged." RA STRUCTURE: "Right atrium is mildly enlarged." INTERATRIAL SEPTUM STRUCTURE: "Not well visualized." MV STRUCTURE & FUNCTION: "Mitral valve is mildly thickened." "Mild regurgitation." AV STRUCTURE & FUNCTION: "Aortic Valve is a tri-leaflet structure." "Aortic valve leaflets are thickened." TV STRUCTURE & FUNCTION: "Triscupid valve is structurally normal." "Mild tricuspid regurgitation." "Estimated right ventricular systolic pressure is 32mmHg." PV STRUCTURE & FUNCTION: "Pulmonic valve is structurally normally without stenosis or regurgitation." AORTA STRUCTURE: "Aortic root is normal." PERICARDIUM: "Percardium is normal." MISC. ITEMS: "Inferior vena cava is not well visualized." CONCLUSIONS: "Technically good, valvular sclerosis, mild triscupid and mitral regurgitation, diastolic dysfunction, biatrial enlargement." NOTE: This report is signed by my cardiologist.

September 13-15, 2012 Reports Regarding Placement of Stents:

PROCEDURE: "Left heart catheterization, selective coronary angiography, left ventriculogram, drug-eluting stent x 2 to the LAD, intercoronary nitroglycerin complex." ANGIOGRAPHY: "Left main coronary arter has ostial 20% disease." "Left anterior descending artery has a medially located moderate diagonal branch that has ostial 20% disease." "At this level the LAD has a very complex lesion that is 95-99% stenosed with what appears to be some thrombus." "The lesion is approximately 18-19 mm in length." "There is then a second diagnonal that is small to moderate size with a more tubular eccentric 70-80% stenoses in the distal LAD that is approximately 11 mm in size." "There is TIMI 2 flow." The circumflex is a large dominant system." There is a small first and second marginal." There is 20% luminal irregularities in the AV groove." There is a large distal posterolateral marginal and then there is 40% to 50% disease in the proximal segment of a large PDA>" "The right coronary artery is small and dominal." "There is proximal 20% disease." LEFT VENTRICULOGRAM: "Left ventriculogram in the RAO projection." "Three aortic valve cusps are present." Left ventricular systolic function is normal." "Ejection fraction estimated at 55%." "The apex is sluggish with some jypokinesis."

CONCLUSION: "Three-vessel coronary artery disease is significant in the LAD distribution representing the culprit." "Successful drug-eluting stent to proximal portion of distal LAD and mid LAD restoring TIMI 3 flow." "Preserved left ventricular systolic function with segmental abnormality."

NOTE: This report is signed by my cardiologist.

PATIENT HISTORY: "Hypertension, mitral valve prolapse, dyslipidemia, chronic fatigue, obstructive sleep apnea with CPAP, elevated cholesterol, elevated triglycerides, elevated LFTs, elevated bilirubin, plasma cell dyscrasia, GERD, Gastric polyps, iron deficiency anemia, testosterone deficiency, colon polyps.

Question: If the VA relies on METS & ejection fraction so much in their rating criteria, is there any chance I will be rated above 0% with my latest ejection fraction at 55%?

I will ask my cardiologist on Thursday about a METS score.

Please give me your thoughts and input as to what my reports indicate, especially the reports from September 2012 and your thoughts on a possible disability rating for IHD.

Thanks...Georgiapapa

[georgiapapa]

Jvretiredvet,

Forgive my ignorance but I do not understand what you are telling me. You definitely have my attention. Please explain your message in layman's terms because I am definitely interested in any information that will help me understand what is going on with my heart.

Thanks...Georgiapapa

[jvretiredvet]

In your post dated 19 September 2012 - 03:48 AM, you asked: If the VA relies on METS & ejection fraction so much in their rating criteria, is there any chance I will be rated above 0% with my latest ejection fraction at 55%?

As you appear to be aware of the terms EVF and METS, I was - perhaps too subtly - suggesting that you review the rating criteria for many cardiac conditions; there are other criteria besides ejection fractions and metabolic equivalents.

So to answer your specific question, yes ... there is a chance (and a very good one IMNSHO) that your cardiac condition will be rated above 0%.

Jvretiredvet,

Forgive my ignorance but I do not understand what you are telling me. You definitely have my attention. Please explain your message in layman's terms because I am definitely interested in any information that will help me understand what is going on with my heart.

Thanks...Georgiapapa

[georgiapapa]

I have started gathering my evidence in preparation for fling my IHD claim through the "Fully Developed Claim" or "Fast Track Process." I obtained copies of all of my medical records from my cardiologist's office and I am not sure if I should send in all of my records as evidence or not since most of the records before September 2012 may not help my claim. I have had several stress tests, echocardiograms, chest x-rays, ecgs, etc. in the past but there was never any strong indication of blocked arteries in my heart prior to this month.

I definitely plan on sending in the cardiologist's "operative" reports from my recent hospital stay, clear 8 x 10 photos of the blockages in my heart before and after the stents were installed, and the DBQ from my cardiologist. Is there any other type of evidence that I should include?

I want my claim package to be complete but not cluttered with unnecessary documents. However, I feel like if I don't send in all of my records, this could cause my claim to be removed from the "Fully Developed Claim" process and placed in the "Standard Claim" process if the VA has to request more records.

Should I go ahead and send in all of my records or just the records from September?

Again, your input is appreciated.

Georgiapapa...

[jcolwell]

I have started gathering my evidence in preparation for fling my IHD claim through the "Fully Developed Claim" or "Fast Track Process." I obtained copies of all of my medical records from my cardiologist's office and I am not sure if I should send in all of my records as evidence or not since most of the records before September 2012 may not help my claim. I have had several stress tests, echocardiograms, chest x-rays, ecgs, etc. in the past but there was never any strong indication of blocked arteries in my heart prior to this month.

I definitely plan on sending in the cardiologist's "operative" reports from my recent hospital stay, clear 8 x 10 photos of the blockages in my heart before and after the stents were installed, and the DBQ from my cardiologist. Is there any other type of evidence that I should include?

I want my claim package to be complete but not cluttered with unnecessary documents. However, I feel like if I don't send in all of my records, this could cause my claim to be removed from the "Fully Developed Claim" process and placed in the "Standard Claim" process if the VA has to request more records.

Should I go ahead and send in all of my records or just the records from September?

Again, your input is appreciated.

Georgiapapa...

[jcolwell]

Not the expert here , but i would send all those records. My husband case is very similar to yours . He has ventricular cardiomyopathy ( CAD) and he has a AICD. If you have a primary care physician you may want to consider sending those records as well if it is non-va doctor. Have you been evaluated for Diabetes or any chronic renal diseaes ( abnormaL lab reports can pick this up )you may want to look at those to make sure nothing is out of order, I did and found out I had both. Hope you dont go down that road. Also, is SSDI something you might qualify for. My problem is I am not boots on ground so have a much harder row to go down. Good luck with all Jim