Cardiologist ...

[Eddy Edson]

The US Society of Thoracic Surgeons has a nifty risk calculator for CABG and other cardiac procedures: https://www.sts.org/resources/acsd-operative-risk-calculator

EDIT:

Summary of the inputs for the calculator:



And the results:



If there really is a ~1% chance of dying under the knife and appreciable risks of other bad things I'm going to need a good story about the benefits of the op before I agree to it.

The plaque is all old ancient calcified plaque which is likely very stable, and with my diet, lack of inflammation etc there is no reason AFAIK to expect further stenosis (or is there?). On the other hand, I don't have any symmptoms (except maybe fatigue?) and my heart doesn't limit my activity levels - I probably do around 70 MET-hours per week of exercise. We'll see what's what after the angiogram.

 

[Eddy Edson]

Nice Christmas present from the cath lab! Result of the angiogram: no severe stenosis, no need for bypass, keep doing what I'm doing.

It found basically the same lesions as the CTCA but <50% stenosis at max rather than >70%, the difference between "moderate" and "severe". This wouldn't have changed over the last 5 years or so, since I changed to very heart-healthy diet, high intensity statin, lots of exercise, lost weight, zapped T2D etc - probably just in time to keep me out of surgery, touch wood.

Moral: Apparently, you never really know what's what until you've had the angiogram.

 

[Eddy Edson]

Some things I've found useful & interesting ...

Paddy Barrett https://twitter.com/Paddy_Barrett is an Irish cardiologist who does brief digestible pices on cardiac health with good references to the evidence base, devoid of Internet woo. Also has a substack: https://paddybarrett.substack.com/

The US ACC/AHA guidance on revascularisation seems like a thorough and detailed review of the evidence as of 2021: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001038 These US guidance docs/scientific statements on CV & related matters are always core texts, IMO, for their detail and timeliness.

 

[nonethewiser]

Nice Christmas present from the cath lab! Result of the angiogram: no severe stenosis, no need for bypass, keep doing what I'm doing.

It found basically the same lesions as the CTCA but <50% stenosis at max rather than >70%, the difference between "moderate" and "severe". This wouldn't have changed over the last 5 years or so, since I changed to very heart-healthy diet, high intensity statin, lots of exercise, lost weight, zapped T2D etc - probably just in time to keep me out of surgery, touch wood.

Moral: Apparently, you never really know what's what until you've had the angiogram.

No better christmas present @Eddy Edson Well pleased for you & your family.

 

[Eddy Edson]

Follow-up meeting with cardiologist today: everything optimised; as you were; catch up again in 12 months if you like but no particular reason to expect any deterioration. The chances are that I'll live until I die from cancer instead of dying sooner from cardio-renal disease 🙂

Which is great but also means he can offer no insight into the original question - ie why I often get an unreasonable amount of post-exercise fatigue & malaise and what I can do about it.

With heart issues ruled out, it's surely due to my gammy PAD-leg, but there seems to be nothing & nobody very useful out there for how best to work around it to get really fit. I'd love to find somebody who knew enough to help me get to a point where I can actually run ...

 

[Proud to be erratic]

Can't offer any help with that @Eddy Edson, but pleased for you that the longer term prognosis is reasonable enough.

By coincidence I had my first cardiac consult yesterday. I went to a busy outpatients department in Oxford and got to see the head of Department, which bodes well. Since various tests, including echograms and 48 hrs on a Holter monitor do not clarify why I'm getting pre-syncopses (very brief giddy periods without going unconcious); the way forward is for me to be fitted with a longer duration monitor system, possibly linked to my smart watch.

Until a recording of an actual presynscope can be taken, it can't be ascertained if these events are attributable to either low or high blood pressure and no treatment plan can be considered. It is frustrating and the giddy spells are very brief but totally disabling for a few seconds - so a bit disconcerting at the time.

 

[Eddy Edson]

Can't offer any help with that @Eddy Edson, but pleased for you that the longer term prognosis is reasonable enough.

By coincidence I had my first cardiac consult yesterday. I went to a busy outpatients department in Oxford and got to see the head of Department, which bodes well. Since various tests, including echograms and 48 hrs on a Holter monitor do not clarify why I'm getting pre-syncopses (very brief giddy periods without going unconcious); the way forward is for me to be fitted with a longer duration monitor system, possibly linked to my smart watch.

Until a recording of an actual presynscope can be taken, it can't be ascertained if these events are attributable to either low or high blood pressure and no treatment plan can be considered. It is frustrating and the giddy spells are very brief but totally disabling for a few seconds - so a bit disconcerting at the time.

What a drag! Hopefully whatever monitoring arrangement they come up with manages to capture an event & there's a straightforward resolution.

Holter monitors and their 2/3 day normal use seem a bit yesterday, right? It can't be very difficult to design something which lasts for weeks and synchs with the cloud. But from my recent experience, I think there's a actually a non-tech limitation at play. Apparently staff have to go through the large amount of data collected and scrub it, because the data stream includes a lot of glitches and artefacts. So here in Oz where you have to pay a bit, at my cardilogy practice you can get extra days but you have to pay more. Dunno what the max is.

 

[Proud to be erratic]

What a drag! Hopefully whatever monitoring arrangement they come up with manages to capture an event & there's a straightforward resolution.

Holter monitors and their 2/3 day normal use seem a bit yesterday, right? It can't be very difficult to design something which lasts for weeks and synchs with the cloud. But from my recent experience, I think there's a actually a non-tech limitation at play. Apparently staff have to go through the large amount of data collected and scrub it, because the data stream includes a lot of glitches and artefacts. So here in Oz where you have to pay a bit, at my cardilogy practice you can get extra days but you have to pay more. Dunno what the max is.

I understood the monitor being suggested would be dormant until I felt giddy, then it would need me to activate it (and possibly also get something tracked through the Samsung Health app). But until I see what the apparatus is it might turn out to have been designed by a committee and not very appropriate. This may be pessimistic and cynical, but my memories are still sharp from urology and catheters!