Assessing risks of delayed angioplasty & stent treatment

[southcoast]

Two weeks ago I was diagnosed with a focal subtotal occlusion of the distal RCA. This after experiencing sudden chest pains while in Asia on vacation, going to a hospital and having a CTA there. At the time, the Asian cardiologist said I needed angioplasty and a stent with some urgency. Now back in the UK on an assortment of drugs, how do I assess my life risks of waiting 6 months to a year for a procedure? The alternative of going private appears remarkably expensive. I am late 50’s and healthy otherwise. I generally like to play a role in managing my own health care.

[Nurse Amy Thompson]

Hi

Have you seen a cardiologist here in the UK? Or are you possibly waiting for an appointment? I'm not aware of any waiting lists for angioplasty and stenting which are 6-12 months long.

What treatment you need will depend upon the severity of disease, and the symptoms that you are having. Single vessel disease of the RCA usually offers a good prognosis, and if you are symptom free it may be that angioplasty and stenting will not benefit your long-term survival - and ultimately may not be indicated at this time. Your cardiologist will discuss the possible treatment options with you, and the associated risks and benefits. If you haven’t been referred to a cardiologist, it is worth speaking to your GP.

The best thing that you can do to reduce your risk is to continue to take the medicines which have been prescribed for you, and make any necessary lifestyle changes.

Best wishes
Amy

[southcoast]

Hi Amy,

Thanks kindly for the response.

I saw my GP the morning I got back from Asia and was referred to a NHS cardiologist. Though my wife and I were told to expect to wait 2-3 months for a first consultation. I was given drugs to help manage my situation in the meantime. We were very grateful, but nevertheless, it was disquieting news. A wait of 2-3 months to see a specialist is not in line with guidance the cardiologist in Asia gave.

I discovered and went to the NHS Choice website http://www.nhs.uk/Pages/homepage.aspx - which by the way, we feel is a major, positive advance in heath provision - the fact that choice is increasingly offered. NHS Choice shows the average wait time for a first appointment with a cardiologist in the hospital I was referred to, is indeed slightly under 60 days.

My general question and the common dilemma that I seek to illustrate is really how do just retired people, otherwise in apparently good health, take an active role in critical decisions about their own health care management? That philosophy is set out in the NHS policy initiative ‘no decision about me, without me’. We warmly welcome the fact that policy provides for shared decision-making (i.e., the patient who knows his/her body and symptoms and has a view on risk management, and the medical specialist). But in this kind of situation, how do we patients assess the life risks, and as a consequence, express a view on whether more urgent attention may be called for or not?

As you can appreciate, my wife and I have now visited almost every medical website available from UK, USA, Canada, and Australia on the topic of cardiac disease and stable and unstable angina, including the various medical journals on current best practice in diagnosis, treatment and prognosis. Plus I know my heart symptoms. I feel I can offer an informed patient voice for the shared decision the NHS promotes.

We do recognise the immense pressure the NHS is under today and will be increasingly in future as the UK population ages. Plus it is true as one economist once said, I am not sure if it was a health economist or not, “not to stress ... in the long run we are all dead”.

On a positive note, my wife and I do look forward to the lifestyle changes immediately required, including the mainly fruit and vegetable diet, plus the rigorous daily exercise routine. That is all good for general health and well-being in retirement.

My new question if, I may, is can we assume that 2 glasses of red wine in the evening are ok to dilate my arteries? I must confess though at the moment I feel that will not be enough!

Kind regards, Southcoast

[Nurse Amy Thompson]

Hi

It seems like you are on the right tracks - and I'm sure your cardiologist will be happy to discuss your concerns and queries with you. There is no reason why you cannot take an active part in your care and treatment.

It has been thought for many years that alcohol may have a beneficial effect on the heart - but only in very small amounts. A small amount of alcohol is possibly thought to improve blood cholesterol levels and reduce the risk of dangerous blood clots forming. HOWEVER, drinking more than the recommended limit is harmful, and can increase your risk of other problems including high blood pressure, cardiomyopathy, stroke, liver disease and cancer. I'm not sure how much you usually drink, but I wouldn't recommend increasing your alcohol intake to try and prevent a heart attack.

Men should drink no more than 3-4 units of alcohol every day - and a large 250ml glass of wine is around 3 units.

All the best
Amy