What can a TEE show?

I thought I might be having a heart attack today, but now think I just panicked. I was driving and got what felt like (and most likely was) indigestion. My chest felt tight and like my bra was too tight. I had recently read about the actress Susan Lucci’s heart attack and stent due to a 90% blocked artery. The tight bra was what she had described. I then started sweating lightly on my face, neck and chest; however, I went off HRT the end of January and still experience this a couple of times a day. I have rarely had indigestion in my life, and no avid reflux or GERD, which is why I panicked.

I don’t think now that is was a heart attack. I am 5’3 and weigh 120, I do not have diabetes, high blood pressure, smoke, and am quite active. My total cholesterol is 153 and my LDL is 11! (Yes, really, and that was not fasting — previous year fasting was undetectable.). For that reason I assumed I do not have clogged arteries.

I had a TEE on 1/31 when I had my Watchman procedure. I will have follow up on 5/27. Does a TEE the probability of a HA or if I’ve had one?

A TEE won't assess the probability of a heart attack, and it's unlikely to detect that you've had one. It might be possible to see evidence of heart damage from a previous heart attack due to abnormal wall motion, but it's not the tool they would use for that purpose. More useful would be a stress test with external echocardiogram, a nuclear stress test, or an angiogram. Based on the health factors you described, I very much doubt anyone would be willing to do any of those tests on you other than the stress test with echo. Your risks are very low, but given the symptoms you described a stress test might not be a bad idea. I would raise the issue with your doc.

Thank you, Carey, I will do so.

Hope your suspected heart attack wasn't one! Perhaps you might also want to find out what your coronary artery calcium score is?
Louise, i hope you don't mind me asking - you don't have to answer; was your LDL measured or calculated (e.g. Friedewald method or other?)
You haven't mentioned Triglycerides?

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Louise
I thought I might be having a heart attack today, but now think I just panicked. I was driving and got what felt like (and most likely was) indigestion. My chest felt tight and like my bra was too tight. I had recently read about the actress Susan Lucci’s heart attack and stent due to a 90% blocked artery. The tight bra was what she had described. I then started sweating lightly on my face, neck and chest; however, I went off HRT the end of January and still experience this a couple of times a day. I have rarely had indigestion in my life, and no avid reflux or GERD, which is why I panicked.

I don’t think now that is was a heart attack. I am 5’3 and weigh 120, I do not have diabetes, high blood pressure, smoke, and am quite active. My total cholesterol is 153 and my LDL is 11! (Yes, really, and that was not fasting — previous year fasting was undetectable.). For that reason I assumed I do not have clogged arteries.

I had a TEE on 1/31 when I had my Watchman procedure. I will have follow up on 5/27. Does a TEE the probability of a HA or if I’ve had one?

I hope you are doing better and that everything has checked out for you. For women, with our hormone issues, it's hard to differentiate our "symptoms." I remember reading the article on Susan Lucci, a little scary and she was apparently in good health.

On your cholesterol, if you total was 153 and your LDL was 11, then that would mean your HDL was over 100? I have never heard of anyone with that high of a number. I think the "scale" they use is not even close to that either. (My total was 142, with HDL being 57. )

Take care.

Joe and Kate, Your questions only confirm my ignorance! Joe, I don’t even know the different measuring tools you are referring to. I get a complete blood test every year and then the results. So I guess whatever is “standard.”

Also I pulled my records since 2014 and realized I misstated my results due to relying on memory! I got years mixed up in my head.

As of October 2018, my total cholesterol was 176, HDL 133, LDL 29 (it went from <10 in 2016, to 11 in 2017, and 29 in 2018). Non-HDL 43 and Triglycerides 72. Kate, I didn’t know an HDL over 100 was unusual. My doctors have only commented on the low LDL.

A “coronary artery calcium score” has never been mentioned to me.

I will see the Nurse Practitioner on May 24 and ask her about these measurements/scores. I am so grateful to all of you who continually educate me! Thank you.

After my last post I did a little research on several sites. It seems that HDL over 100 “could lead to higher incidents of heart attack or death.” Naturally that is not good news for me.

But I then read that the risk is not that great when LDL and Triglycerides are under 100. Still food for thought and something I will definitely ask about.

I have not seen my EP since my Watchman procedure. All follow-up appointments have been with the NP. Hopefully, when Dr. Doshi does my TEE on a May 27 he will see me afterward and I will be able to talk to him.

My (thankfully limited) experience with surgeons is that they are super attentive when they are selling the surgery, but then literally “cut and run,” and don’t even recognize you in their office.

Don't underestimate the knowledge level of nurse practitioners and PAs. In most cases I'd say you're better off getting followup care from a NP or PA than a doctor. Although they may lack the skill set of the doctor when it comes to the procedure itself, their skill set at followup care is usually superior. Don't expect that you'll get better, more knowledgeable, or different answers from the doc than you will from the NP.

Your cholesterol and triglyceride numbers are enviable. They're so good you really shouldn't even be thinking about them.

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Louise
After my last post I did a little research on several sites. It seems that HDL over 100 “could lead to higher incidents of heart attack or death.” Naturally that is not good news for me.

But I then read that the risk is not that great when LDL and Triglycerides are under 100. Still food for thought and something I will definitely ask about.

I have not seen my EP since my Watchman procedure. All follow-up appointments have been with the NP. Hopefully, when Dr. Doshi does my TEE on a May 27 he will see me afterward and I will be able to talk to him.

My (thankfully limited) experience with surgeons is that they are super attentive when they are selling the surgery, but then literally “cut and run,” and don’t even recognize you in their office.

I did not mean to cause you concern! I've just never heard of an LDL that low. I'm sure you are fine. Take care!

No worries, Kate. We’re all sharing here — how I interpret things is not the responsibility of the poster! Good health to you. 😁

Hi Louise - i noticed that you also said that you recently had a Watchman. How did you make that decision to do that, and how was the procedure? Do you have any regrets? It's something I am considering, to get off of Eliquis.

thanks ~ Barb

Hi Barb, I made the decision precisely to get off Xarelto. I hated taking blood thinners at all. The procedure was nothing. Really, I came home the same day ( I begged my Dr for this and he scheduled me first one of the day.) I really don’t think it’s necessary for anyone to stay overnight after a few hours unless they have other issues or complications— I think the hospital wants the money — just my cynical opinion. 😀. Anyway, I lay around the next day but no pain; just a slight ache in my groin where the catheter went in. I used it as an excuse to lay around and read, but I could have done more. Day 2 I didn’t feel like anything was done. My doctor has me on Clop... (I can never remember how to spell it) generic Plavix... and aspirin for 60 days and then just aspirin. It was totally covered by Medicare supplemental insurance. Versus blood thinners I would highly recommend it.

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Louise
It was totally covered by Medicare supplemental insurance.

That's very interesting. Last time I checked Medicare was only covering LAA occlusion devices for people who couldn't tolerate anticoagulants. Did you have to go through any special approval requirements?

No, I wasn’t aware of that.

Carey, my husband just told me that the Dr had to get it approved. I don’t remember the conversation, but I have a hard time remembering details when I go to the doctor. I don’t know what the criteria was but I do remember him saying I wasn’t a good candidate for an ablation based on how long I have been in permanent AFIB. I honestly don’t remember all the questions.

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Louise
I do remember him saying I wasn’t a good candidate for an ablation based on how long I have been in permanent AFIB.

A more experienced EP would give you a different answer. Afib can be persistent, but it's never permanent unless you choose to let it be.

If you could quiz your husband more about the process of getting his Watchman approved by Medicare, I'd be really interested in hearing about that, as I'm sure others would.

I should have said persistent. There was also a post on here about having it so long; but I’d be hard pressed to find it now. I have rarely heard of anyone having “one and done” and since I’ll be 70 in June it would be a bad time to have a “first” one. Also, from my perspective, I would still be on blood thinners and most likely still have AFIB , so it wouldn’t really change my life to have an ablation. My EP is not a novice and has a very good reputation. The reason I went to him is because a friend had an ablation with him many years ago and it actually was one and done so far.

Perhaps it was approved because I bleed so easily when on Xarelto. I am terrified of internal bleeding because it happened to my mother on Pradaxa. I went off completely and took Cardiokinase for a year and if I cut myself in the kitchen or something there was very little bleeding compared to Xarelto. My PP talked me into going back on Xarelto but I gave up biking or anything where I might get hurt and start bleeding.

I have never asked, but are you an EP? I’ve just always assumed you were a doctor. I know you have a Watchman but I think you were part of the first study, right? Thank you again for all your input!

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Louise
I have rarely heard of anyone having “one and done” and since I’ll be 70 in June it would be a bad time to have a “first” one.

Do you realize that most ablations are one and done? You don't hear about them because the people who have them don't come to forums like this. They just forget about afib, get on with their lives, and never come here. And there's nothing too old or too late about being 70.

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Perhaps it was approved because I bleed so easily when on Xarelto. I am terrified of internal bleeding because it happened to my mother on Pradaxa. I went off completely and took Cardiokinase for a year and if I cut myself in the kitchen or something there was very little bleeding compared to Xarelto. My PP talked me into going back on Xarelto but I gave up biking or anything where I might get hurt and start bleeding.

I have never asked, but are you an EP? I’ve just always assumed you were a doctor. I know you have a Watchman but I think you were part of the first study, right? Thank you again for all your input!

Being terrified of bleeding won't get you approved for a Watchman. And honestly, I think you fears of bleeding are misplaced. You should fear stroke far, far more.

Ha ha. No, not an EP or doctor of any sort. I have a Watchman because I lucked into being included in one of the clinical trials for the Watchman FLX, a second generation version of the device. Not the first by any means. The Watchman has been approved in Europe and the US since at least 2015. (2014? Too lazy to look it up.)

Carey, it wasn’t Medicare that paid for my Watchman. I realized you didn’t see the “supplemental insurance.” For me that was Blue Shield.

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Louise
Carey, it wasn’t Medicare that paid for my Watchman. I realized you didn’t see the “supplemental insurance.” For me that was Blue Shield.

I'm still surprised they paid for it. That's a welcome change. Every insurance company I've heard of up until now has taken the position that they'll only pay for Watchman-type devices if the patient can't tolerate anticoagulants.

Well... that’s all I got! 😅

Louise:

I have medicare also Blue Cross/blue shield, Medicare pays 80%, Blue Cross pays 20%, that is the way it is. Blue Cross doesn't pay for all of it.

Liz

Louise,

I'm curious what changed at BC/BS and Medicare that they approved your Watchman. As I said, in the past their policy was to approve the device only for people who couldn't tolerate anticoagulants. Did your EP intervene on your behalf in some way, for example by making a case that anticoagulants were inappropriate for you somehow? Were you at higher risk of stroke because you've had your LAA isolated Or did you simply ask for the device because you wanted one and they approved it?

Carey, I really have no idea. I had an appointment and we discussed my history, current situation, ablation, etc. I asked him about the Watchman and he said he thought it would be a good option but didn’t really talk to me about getting it approved or the process or anything. My husband said he heard him say something about getting approval and said (I don’t remember her name) would call me to schedule the procedure, which she did.

Well, maybe Medicare has changed their policy, and I believe the way it works is BC/BS would have to follow the same policies.