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Question:
Although my stent procedure was successful, my ventricular function is abnormal. Can you help me understand why?
Had cto lad stented 2 years ago. Cath one year ago normal. After echo showed problems cath last week showed no new blockages but left ventricular systolic function is moderately impaired, wall motion abnormal, hypokinetic and left ventricle mildly enlarged. How can this be happening when a year after stent placement all was normal and now things are deteriorating for no good reason? Don't smoke, drink or drugs, only healthy food, supplements. Thanks.
submitted by Jason from North Carolina on 04/15/2015
Answer:
by Texas Heart Institute cardiologist, Scott R. Sherron, MD
I am sorry to hear that you are having deterioration in LV function. Several possibilities exist that may explain this kind of outcome after a successful procedure. First, the LV can have suffered damage from the time that the LAD was closed prior to the stent 2 years ago. This could be from a known or unknown infarction likely at the time of the original occlusion. Up to 20% of heart attacks are silent. Alternatively, it could be related to chronic ischemia (inadequate oxygenation due to poor blood flow) which sometimes leads to stunning that recovers, but other times can leave permanent injury to some of the heart muscle cells. Sometimes that damage is less obvious at the time of cath and could even be evolutionary changes that occur gradually after the initial insult through remodeling of the ventricle and changes in geometry including gradual dilation. This change might not be detected on a routine heart cath 1 year ago if it was primarily a coronary angiogram and did not include an LV gram (which they often would not). The above statements presume that the LV dysfunction went undetected until recently and of course that may not have been the case. If a more recent echo or other assessment of LV function was normal and then the current findings developed, it suggests a non-ischemic etiology. There are other diseases that can cause dilation of the ventricles and progressive weakness such as viral cardiomyopathy or valvular heart disease. Hope this is helpful.
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Updated April 2015
