I Didn'T Have A Stroke.

[kerryk]

A couple of weeks ago I was preparing for a stroke and wrote a post to that effect.

Sheryl gave me some excellent advice.

I ended up having chest pains while I was close to Bangkok Rayong hospital. Not severe chest pains but I thought the pain and tight feeling was a symptom of something more serious. I was waiting to eat when I began to sweat profusely, feel nauseous, dizzy and began to have pain in my chest.

I went home first and laid down but it did not get better so I arranged transportation to the hospital. We got there at 7PM and the heart specialist wanted to transfer me to Bangkok Pattaya (two hour drive) for a balloon and stent thing. He had done an EKG and was looking at a ultrasound of my beating heart while he talked to me. I was kind of surprised Bangkok Rayong did not do the procedure. I asked him about Sirikit thinking it would be cheaper but he told me Siriket did not do it. He said Bangkok Pattaya charged around 300,000 Baht so I told him to try something less expensive and we settled on the clot busting drug which was around 100,000 baht for the drug.

I took a lot of drugs and was in the ICU for 3 days hooked up to monitors and two days in a normal room. It appears to have worked as my BP has gone from 180/90 to 130/70 with my pulse 50. While I was in the hospital my BP went very low 100 and 90/50. The total cost was around 178,000 baht for the ICU, drugs, doctors and everything. They gave me a stress test (running on a treadmill hooked up to an EKG) before I left the hospital and it did stress me a bit but I passed the test so apparently the clot busting thing worked. There was some doubt I got there in time. I couldn't remember if the event occurred 3 or 4 hours before.

In addition to the clot busting drugs or maybe part of the treatment they gave me injections in my stomach twice a day for 4 days that have turned a football sized area of my stomach black and blue since I have been home. Some of the nurses gave the stomach injections without pain and others hurt like heck.

[kevjohn]

Glag to hear that all is well.

[Sheryl]

In my experience it invariably happens that when people are focused on a particular possible health problem, that will not be what they get.

But, if you had a clot in your coronary arteries, you are certainly at risk of future clots which could indeed be in the brain.

The stomach injections are anticoagulants. You may be placed on long-term anticoagulent therapy in which case will need regular blood tests for life and certain other precautions you should read up on (especially before dental work or anything else that might cause bleeding). Most important of all being to keep your BP in normal range, since while anti-coagulants decrease the risk of blood clots they increase the risk of cerebral hemorrhage.

Any underlying risk factors that led to this, if known, need to be addressed urgently..

If you want to find out if you are on the path to a major stroke, you can get a test called a carotid doppler, it is non-invasive and will show if the carotid arteries are at all narrowed or partially blocked, if they are, there are interventions to unblock them and thus reduce the risk of catastrophic stroke. I would not recommend this test routinely but as you have had a coronary artery occlusion you are in a risk category and if I were you, I'd see a neurologist and make sure my carotids were normal. (Normal carotids do not rule out the possibility of a stroke later in smaller blood vessels but do make a truly catastrophic stroke less leikley.

[kerryk]

In my experience it invariably happens that when people are focused on a particular possible health problem, that will not be what they get.

But, if you had a clot in your coronary arteries, you are certainly at risk of future clots which could indeed be in the brain.

The stomach injections are anticoagulants. You may be placed on long-term anticoagulent therapy in which case will need regular blood tests for life and certain other precautions you should read up on (especially before dental work or anything else that might cause bleeding). Most important of all being to keep your BP in normal range, since while anti-coagulants decrease the risk of blood clots they increase the risk of cerebral hemorrhage.

Any underlying risk factors that led to this, if known, need to be addressed urgently..

If you want to find out if you are on the path to a major stroke, you can get a test called a carotid doppler, it is non-invasive and will show if the carotid arteries are at all narrowed or partially blocked, if they are, there are interventions to unblock them and thus reduce the risk of catastrophic stroke. I would not recommend this test routinely but as you have had a coronary artery occlusion you are in a risk category and if I were you, I'd see a neurologist and make sure my carotids were normal. (Normal carotids do not rule out the possibility of a stroke later in smaller blood vessels but do make a truly catastrophic stroke less leikley.

Thanks again for the great information. The doctor had me hooked up to the doppler thing as soon as I got to the hospital and after the ECG that is how he saw the clot. I have a follow up appointment and blood test in two weeks and I will ask him about the carotid doppler test.

Forgive me for being such a dummy here but when he was looking at my arteries (with the doppler thing) after the clot blocking drugs were administered would not he have looked for blockages?

Three days after the clot blocking drug was administered they hooked up 8 or 10 or more leads to my chest and put me on a treadmill. I assumed because the leads were in different places they were measuring blood flow in different arteries. Is that correct? It was an ECG exercise stress test. The results said Functional Capacity: class I BP response to exercise normal. Conclusion: Negative submaximal exercise Functional class I. At the end of the test it says, "The resting heart rate of 71 beats per min rose to 100 bpm (exercise). This value represents 64% of the maximal, age predicted heart rate. The resting blood pressure of 117/65, rose to a miximum BP of 162/83. The exercise test was stopped due to target workload achieved. What does that mean?

[Sheryl]

The leads are put in different areas because that is necessary to capture the electrical impulses of each heartbeat. It does not separately look at different arteries, it gives an EKG reading and then the doctor observes for signs of ischemia (insufficient oxygen reaching the heart muscle) as you exercise, if present these will show as changes on the EKG.

To my reading your test result is negative for ischemic changes i.e. good, but you should discuss in depth with your doctor.

When they did the doppler of course they looked for blockage but only in your coronary arteries.