In June of 1996 I had a mild heart attack. The family has had a history of cardiac problems, and I was overweight, had basically given up all exercise, and was smoking the occasional cigar. In the spring of 1996 I had asked my doctor, Walter Caskey, to change my blood pressure medication, and soon he did I began to get angina pain during even moderate physical activity (like walking to the train station after work.).
I reported this to my doctor, and I was handed a prescription for nitroglycerine tablets, and was set up with an appointment for a stress test. Alas, a few days before the appointment was scheduled, I was out driving, got a flat tire, changed it, and felt lousy enough immediately afterwards to check into the hospital.
It took several hours for the hospital staff to determine that I had actually suffered a heart attack. The damage was very slight. I was soon stabilized, and an angiogram eventually showed a classic, straight blockage in the left anterior descending (l.a.t.) cardiac artery.
A successful balloon angioplasty reopened the artery, and I was released from the hispital to began cardiac rehabilitation. Rehab included regualr exercise, and a drastic change in my diet.
Rehab went well but, unfortunately, as it happens about a third of the time, the artery shut down again after about three months, and so in October of 1996 I underwent another angioplasty, this time with leaving a stent in place. Here are the before and after stills from that procedure:
After the stent was placed I re-started my rehab under the watchful eyes of Fern Cooper, RN, at the Faulker Hospital. Ultimately I lost close to 60 pounds (starting at 230, although I gained back about half of that.) I was out of rehab, but I continued a low-fat diet, maintained a pharmacological program of beta- and calcium-channel-blockers and I exercised rigorously and regularly.
My cholesterol had never been very high, but my 'good cholesterol,' HDL remained pretty low. A couple of glasses of wine in the evening helped raise the HDL, and my spirits. By late 1999, however, a statin, Lescol, was added to my pharmacological program to work the cholesterol even lower.
I seemed stable enough to my doctors and friends, but in July of 2000, I felt renewed angina pain, and after another angiogram a new block was discovered, also in the l.a.t., but below the original stent location. The angiogram did indicate some good news: it showed that the original stent was still in good shape. Furthermore, all the blood tests indicated that I had not suffered another heart attack. So I was sent off to Brigham and Women's for another angioplasty and stent.
All the doctors seemed to think that this episode was just a little adjustment of the plumbing, and that generally I was in good shape. My cardiologist suggested that the block could be an example of 'junction stenosis,' or a block that forms downstream from a stent near the next arterial junction. My original stent, a Palmaz-Schatz from Johnson & Johnson™ is rather inflexible, and apparently can create eddies downstream which can irritate the artery lining, inviting another plaque to form. Sounds plausible, but who really can say? In any event, the new stent is from AVE™ (Arterial Vascular Engineering) and is more flexible.
My former GP was Walter Caskey, and after my heart attack he set me up with Dr. Gary Brockington as my cardiologist. Dr. Brockington's former partner, Dr. Greenwald, performed my first angiogram, and happened to be the physician at a stress test in early 1999, which I passed rather easily.
Dr. Caskey retired soon after my initial heart attack, and now my GP is Dr. Linda Lauretti.
All of the Doctors named above are associated with Faulker Hospital, my 'neighborhood' hospital in Roslindale MA. Faulker is a good hospital, but they are not equipped to do open heart surgery. So while they can perform angiograms and have a cardiac intensive care unit, by rule they cannot perform actual angioplasty. My first procedures in 1996 were performed at New England Medical Center, which was where Faulkner normally referred cardiac patients. My first stent was placed by Dr. Lawrence Conway.
Lately, NEMC, which was virtually bankrupt at the time of my hospitalizations, has merged with a for-profit hospital corporation, and Faulker has merged with several large Boston-area teaching hospitals, including Brigham and Women's Hospital. Dr. Andrew Selwyn, who performed my most recent angiogram at Faulkner, is Director of the Cardiac Catheterization Laboratory at Brigham, and Dr. James Kirshenbaum, who placed the stent, is Co-Director, Clinical Cardiology. Dr. Kirshenbaum is also responsible for finally getting me the images of the most recent procedures.
You have to be conscious during an angiogram (for various reasons,) and I was pumped full of valium anyway, so I was fascinated by what I saw during my first angiogram, and decided I wanted a copy of the video tape. Dr Greenwald said he could make one, but he'd have to convert the format, etc. After several months of asking and several different excuses ('the duplicating machine is broken') I gave up on that.
At the time my first stent was placed at NEMC, however, I asked again for tapes, pictures, anything I could get my hands on. Dr. Rajendian (I hope I've spelled his name correctly) provided a couple of black and white glossies, reproduced above. I later colorized one of the images and made a tee-shirt out of it.
When I was admitted to Brigham and Women's in July 2000, Dr. Resnick, who did the initial screening, promised me a CD of images from my procedures. The CD was a long time coming, and I only got it through the good graces of Dr. Kirshenbaum, who warned me it might not be as useful as I thought. In fact, it is in a proprietary format called DICOM 3 (Digital Imaging and Communication in Medicine.) As a CD, it's great. There are ten video sequences, and a custom executable which can select and play a sequence, adjust speed, contrast, etc. Unfortunately, it's not portable at all, and the interface program has no facility for exporting or printing. So to get images I have to take screen shots. To get videos, I have to play the images frame by frame, take a screen-shot of every frame, and then crop and re-animate them. Nevertheless, I am glad to have the CD for my records.
I've taken some of the best sequences from the CD and created animated GIF files. You can see the beating heart with blocked artery, sequences showing the stent actually being placed, the beating heart with the stent in place and restored circulation. These animated GIF's are rather large, so they'll take a while to load. Click the links below to see them.
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