Q: After a coronary stent procedure, what exercises can I perform?

A: After a coronary stent procedure, exercise is important but it is imperative what type of exercise is performed. For the first four to six weeks, after undergoing a stent procedure (eight weeks after implantation of DES), patients should refrain from any weight lifting, climbing, TAEBO, contact sports, baseball, softball and Tennis. Aerobic exercise like jogging, walking, or biking is acceptable.

Q: I have heart disease. What medications or drugs should I avoid?

A: For a complete discussion, please click to INSTRUCTIONS FOR PATIENTS under PRECAUTIONS. The list of medications to avoid for heart patients is growing every day. The short list is: Vioxx, Inapsine, Actos, Imitrex, Viagra, Levitra, Cialis, Sudafed, Erythromycin, Levaquin and other Quinolone Antibiotics, Tricylic Antidepressants, chemotherapeutic agents

(Adriamycin and their related chemotherapeutic drugs), and Pletal.

Q: I had a stent procedure for a coronary artery blockage one year ago. How often do I visit my Cardiologist for follow-up?

A: If you are not experiencing any chest discomfort or any symptoms, you need not go to your Cardiologist more than once a year. However, you must follow up with your primary care physician for following cholesterol and lipid panels especially if the cholesterol was elevated in the past. You should get a stress test of some type 3 months after your stent implantation procedure and then annually thereafter. Even though the current drug eluting stents (DES) have a restenosis rate after one year of 3.1%, after 3 years (even with DES stents), the restenosis rates can rise up to 8% (TAXUS 3 year data for long coronary blockages).

Q: After my stent procedure, how long should I continue Plavix or Ticlid?

A: I recommend Plavix or Ticlid for one year after implantation of a stent (see PCI-CURE trial, NEJM, 2002). If the stent implanted is a Drug Eluting type (DES), I recommend continuing Plavix or Ticlid for at least one year. If a surgery is required, it must be an of an emergent life threatening nature. However, with Plavix or Ticlid on board, the patient undergoing surgery is at significantly higher risk of post-operative bleeding complications. That is why I recommend elective surgeries be postponed for at least one year after implantation of a drug eluting stent (DES).

Q: When can I drive after bypass surgery?

A: I recommend waiting at least 8 weeks before starting to drive. Driving requires the use of pectoralis muscles of the chest. The chest muscles insert into the sternum. The sternum is the bone the surgeon cut in order to access the heart for the open heart surgery procedure. Bones including the sternum require at least 6 weeks to heal properly.

Q: How long after my stent procedure can I engage in sexual intercourse?

A: If only one vessel was diseased and that vessel was successfully stinted, I recommend waiting at least one week before engaging in sexual relations. The leg artery called the femoral artery needs also to heal adequately. Also, I don’t recommend Viagra or similar agents in any patient with heart disease especially coronary artery disease.

Q: I am feeling fine. I walk a mile a day. My Doctor says my heart is weak and I need a special pacemaker called an AICD. Why should I get a procedure if I feel fine?

A: In general, that’s a good plan. There is no need to proceed with any surgery with its attendant risks if you don’t have symptoms. However, this is one of those very few times I make an exception to that rule. People with heart failure often don’t have any symptom. In fact in the SPAF trial in the early 1990s, up to 30% of people with documented low heart function did not notice any symptoms. People with weak hearts (with heart failure where their heart is not able to pump greater than 30% of the blood it receives from the lungs), have a high likelihood within the next hear of dying from a fatal rhythm disturbance called Ventricular fibrillation or Ventricular tachycardia. So far we have not been able to isolate any factor that can successfully prognosticate who with low heart failure with develop this fatal heart rhythm disturbance. The one factor that was identified is low heart function. Remember, you must be having heart failure for at least 3 months before you are allowed to get the AICD. You must be on heart failure medications for 3 months and only if the heart medications fail to correct the heart failure can you receive the AICD. The AICD implantation is not a small surgery and must be performed by a Board Certified Eleoctrophysiologist (a Doctor that specializes in Heart Rhythm disturbances).

Q: Are there other “clot busting” drugs to assist in clearing the remaining blocked arteries after a stent or balloon procedure opens the most blocked arteries?

A: This is the challenge of cardiologists today. We as Cardiologists can fix (or open) the most blocked artery with a balloon angioplasty (PTCA) or stent, but what about the not so critical <50% blockages? Medicines presently at our disposal are powerful enough to stabilize these <50% blockages if not cause some regression of the plaques. These drugs are statins and antiplatelet drugs. Statins have shown in multiple different trials (PLAQUE, 4-S, WOS, AFS-CAP, etc) that even though coronary angiograms do not show little or no change in plaque morphology, patients on these statin drugs require 35-40% less hospitalization for heart catheterization, PTCA or bypass surgery. “Clot busting” drugs consist of TPA, retavase, and tenectaplase and are used to open acutely blocked arteries during an acute heart attack. They are given via injection or via IV and are not approved as oral agents to be given as “prophylaxis” in the prevention of heart attacks in people without symptoms even though they may have known coronary blockages. Aspirin, Plavix or Ticlid are anti-platelet “blood thinner” type drugs presently approved for use in the prevention of heart attacks in patients with known coronary blockages.