I’ve had a heart attack, a myocardial infarction (MI). So says a cardiologist, anyway. It could be due to a blockage in the left anterior descending (LAD) branch of my left coronary artery, which the angiogram found to be 30% – 50% obstructed. This branch of the coronary artery system is known as the widowmaker because of its proclivity to obstruction and the likely outcome of a significant blockage.
CT scan of my heart arteries – the Left Anterior Descending artery
Perhaps this is a warning of bigger things to come. I suppose the cardiologist is correct about the MI- he’s basing this call on the fact that I had high levels of troponin in my blood, a substance which is released from damaged heart muscle. My symptoms aren’t a good guide as I have pain in the chest region from two likely osteoporotic fractures in the thoracic spine and yet another broken rib (right anterior rib 4?). Further, an ECG and stress-echo test were both fairly normal. On the other hand, two investigations ordered by the cardiologist, coronary artery calcium scoring and coronary artery angiogram, did show plenty of cause for concern (report page 1, report page 2) and tend to support his diagnosis (and also suggests that I have a ‘hole in the heart’ – patent foramen ovale). Regardless of whether an MI has already occurred, I’ve now started on medication I’ll take for the rest of my life – however short that period may be:
“And don’t do any activities you’re not used to“, advised the cardiologist. I didn’t find this or any of his advice very useful, nor do I think he did a very thorough job of investigating my particular case. He didn’t measure fasting cholesterol levels, and didn’t really listen to me describe my symptoms; he just wanted to hear me say “chest pain“. He seemed determined to go through a standard investigative routine (and in the process keeping his own stress-echo lab staff employed), leading almost inevitably to the three drug treatment he ended up prescribing. The total bill for the cardiologist’s consultations and investigations was $1700! If I’d asked my GP to prescribe a treatment, with no more information than the troponin result she had already discovered, I reckon she would have come up with almost exactly the same regimen, at zero cost to me.
The cardiologist wants to see me again in 3 months’ time. Right now I’m thinking I’d rather spend his consultation fee on something useful instead.
Anyway, the SAH CT scan has provided enough evidence to convincingly support the argument that all is not well with my heart. I will heed the warning and will consume these three medications, hoping they will do more good than harm. And I’ll make sure I’m carrying a phone all the time, ready to dial the emergency ambulance if the widowmaker decides to step up the attack to the next level.