• Community Members
    Nov. 7, 2017, 5:05 p.m.

    I'm a 52 yr old male in good physical health have worked out, both cardio and resistance, my entire life. Never had any heart issues or symptoms until a year ago when I was working out got light-headed and had some very mild chest discomfort. Over the next 2 weeks I was in the ER five times thinking I might be starting to have a heart attack. All bloodwork normal, no positive signs for HA. This lead to a stress test with nuclear imagining, 24/7 heart monitor for 20 days, heart echo.... all negative. And eventually lead to a catheterization angiogram at Univ of Madison, WI hospital. There was no obstructive coronary disease found, but a 'prominent' myocardial bridge (MB) of the LAD was noted. I was told it was a benign finding and would not cause symptoms. From there I have been to the Cleveland Heart clinic (#1 in the nation) and told the MB was benign, Mayo Clinic in Rochester who repeated all heart test and told the MB was benign and heart was fine, and finally Stanford Medical in CA who has a myocardial bridge specialist by the name of Dr Schnittger. She looked at the cath angio film and said the MB is very significant and the LAD is obliterated during diastolic. Stanford then did another cath angio with specific testing of the hemodynamics of the MB and found the fractional flow rate (FFR) to be only .72 (anything less than .8 is bad). (FFR is the single most important measurment in defining the significance of an MB, or a static diseased vessel, but most places do not have the means to measure it.) Dr Schnittger believes unequivically that I should have debridging surgery to release the LAD from the bridge. While not a common surgery, it has been performed since the 70s and has proven to be very successful at resolving symptoms with very few surgical complications. To date I have not undergone surgery as I feel normal on a day to day basis, the only time I feel any symptoms is during exercise and if I don't push it, keep heart rate <140 and stay under 40 minutes of exercise, I basically have no symptoms. If I push it beyond those limits, my heart rate will stay in the 80s for hours after the exercise (normal resting is mid-high 50s) and I will feel like all the energy has been sucked out of my upper body... very weak for several hours. Surgery can now be done without a sternotomy, with a beating heart (no heart lung machine) and in a few very select centers completely robotically. Feel free to contact me if you would like any more specific info, I have a ton.

  • Nov. 11, 2017, 4:23 p.m.

    This is so interesting Drew, can't thank you enough for sharing your story!

    I think you share my relief for when I finally found Dr Schnittger. It was a life changing revelation when we figured out how my MB had interacted with a DVT blood clot to trigger a heart attack which allowed the blood clot to form in my heart. Until then, it was a big mystery. That revelation allowed me to stop taking Coumadin/Warfarin, which was just huge for me. I love snowboarding, trail running, cycling, etc... all things that are a little more dangerous if you're on blood thinners.

    Just curious, do you think you'll eventually get the surgery? Are you just waiting to see if your symptoms get worse before doing it?

    Totally understand being apprehensive about it, unless it's completely necessary, I would put it off also. Open heart surgery was enough fun for me ;)

    btw, are you taking any precautionary medications for your MB?

  • Community Members
    Nov. 13, 2017, 5:54 p.m.

    I missed the fact that you had been to Stanford and saw Dr Schnittger in your original post. I guess I'm no more of an expert than you :) I do not take any medication right now; although I was prescribed I think it was a beta blocker to slow the heart rate down and reduce the strength of contractions. However, I was diagnosed as 'bradycardia' with a resting HR frequently in the low to mid 50s. Since I have no symptoms when I'm doing normal day to day activities; including moderate exertion like mowing,etc. , I couldn't justify taking the med. Why would I take it? So, that I could push my heart harder without symptoms...??? Didn't make sense to me.

    I do have coronary classified plaque proximal to both MB's, I actually have (2), a second smaller was identified at Stanford. Interestingly, I had a heart CT scan at 40 years old, I was asymptomatic but was just curious. It showed a small amount of calcification in the LAD which put in the worse 10% risk for my age group. (Calcification as you probably know is calcified coronary plaque) 90% of 40yr old males would have no calcificiation. I didn't know I had an MB at that time, so I was completely stumped by the finding. I was in great shape at the time and back then the CAC scoring was still sort of new science or at least had not been widely accepted in the medical world, so all the cardiologists I saw at the time gave it no value and told me not to worry about it. I now know that an MB will almost always have coronary disease/plaque proximal (just before) to the MB. They believe it is caused by the change in bloodflow caused by the MB. To confuse things, it is commonly accepted within the cardiology world that MBs protect the artery directly under it from coronary disease. So, while they will always find disease proximal to the MB, they never find it directly under it. Stanford and a few others believe the MB is causing the plaque, most believe it is preventing the plaque. If I knew for sure which was correct it would help me with my surgery decision. If the MB is causing the plaque, then debridging should stop or slow its progression... there is no science to support the theory. If MB is protecting, will plaque acclerate after debridging..?

    I'm scheduled for robotic debridging 12/18/2017, but I have made no plans to support it. My gut tells me it is the right thing to do, but my risk aversion won't let me go there.

    When you had the open heart surgery did they debridge your MB? or just remove the blood clots?

  • Nov. 26, 2017, 3:09 p.m.

    We both have clearly had some unique issues, maybe with our combined experience we're almost an expert? lol

    I left out the details of my Dr in my original post. I'm new to participating in online discussions and wasn't sure how detailed I should be. That said, I think it's important to lay it all out so people can read our stories and hopefully find answers to their own issues. Your posts are helping me with that :)

    I hear you on the hesitance to taking meds. I typically shy away from everything. Having been on Coumadin, it made me apprehensive because there were so many interactions. It was easier to just struggle through a cold than to take a new medication for a few days and potentially mess with my INR. As for the Metoprolol/Aspirin/Lisinopril I currently take, it all seems to make sense given my past issues, but if I hadn't had those I think I would be on the same page as you. At this point, I put a lot of value in Dr Schnittger's recommendations. Although I agree with you, there are a lot of conflicting opinions on some of the things she says, but I don't know if those opinions are coming from people with as much experience as she has in this specific field (MBs)?

    When I had the open heart surgery they did not debridge my MB, they just removed the clot (it was attached to the inner wall of the left ventricle). At the time they did not know I had an MB. Which is where the mystery began, since typically you would not see a blood clot in a healthy heart and there is no way for a clot to pass through the heart into the left ventricle. This led me down a path to figure out how it got there. I swear I heard this so many times from different experts: "blood clots don't form in your heart unless you have damage, like a heart attack...but you're young and healthy and obviously haven't had a heart attack!" (usually followed by a shrug and scoffing at the idea)... and so the mystery continued. Well, turns out, I did have a heart attack. Which we didn't find out until my doctor at University of Colorado took some interest and decided to do an MRI, which showed the scarring. My first visit with Dr Schnittger years ago, she found the MB (through stress test), but did not connect the dots that it had interacted with my original pulmonary embolism and CAUSED a heart attack. When I went back to her last year with the new heart attack revelation, we finally pieced it all together.

    Pretty crazy set of interactions. Also crazy that I still have no idea when the heart attack happened. My theory is it happened during the bilateral pulmonary embolism, I was in so much pain that I'm guessing it masked any additional pain from the heart attack.

  • Community Members
    Nov. 27, 2017, 5:39 p.m.

    Who actually removed the blood clot, was that done in Colorado? How did they identify the blood clot... and by the way that all sounds crazy scary.... I'm assuming you had some pretty severe symptoms prior to identifying the clot? I'm scheduled for robotic surgery, but I'm scared to death I'll wake up intibated in the ICU to learn they had to switch to a sternotomy due to some complication...... eeecccc..... :)

  • Nov. 30, 2017, 4 p.m.

    Yep, the open heart surgery was done in Colorado.

    I'm going to respond to your question about my symptoms in another thread. I find that thinking about one piece of my story brings it all back. I don't know if this is a normal thing for survivors or if it's just me, but I hope my story helps someone. Cheers Drew, thanks for asking :)

    Symptoms, treatment and recovery from open heart surgery to remove a blood clot

  • edit

    Thread title has been changed from Drew Mycardial Bridge expert.